HypothalamusDescendingautonomicpathwaysSuperior cervical ganglionSuperiormesenteric ganglionInferiormesentericganglionCeliacganglionEyeBlood vessels of headGlands associatedwith eye, nasal cavity,and oral cavityRespiratory systemCirculatory systemDigestive systemUrinary systemReproductive systemKidneyPreganglionic neuronPostganglionic neuronS1L2T12T1C1CXSympathetic trunkGrayramusSweat glands (sudomotor)To peripheral bloodvessels (vasomotor)Hair follicle muscle (pilomotor)Vasomotor fibersto lower extremityAdrenal
Figure 25-3. The sympathetic (thoracolumbar) division of the autonomic nervous system. Preganglionic fibers extend from the intermediolateral nucleus of the spinal cord to the peripheral autonomic ganglia, and postganglionic fibers extend from the peripheral ganglia to the effector organs, according to the scheme in Fig. 25-1. (Reproduced by permission from Noback CL, Demarest R: The Human Nervous System, 3rd ed.
New York, McGraw-Hill, 1981.)
Renal plexusCeliac plexusMesentericplexusesSuperior hypogastricplexus (presacral n.)InferiorhypogastricgangliaSympatheticchainTh 11Th 12L 1L 2L 3L 4Pelvic nerves(parasympathetic)SacralPlexusPostganglionicparasympatheticfibersInternal sphincterExternal sphincterHypogastricnervesSacralnervesInt. pudendalnerveAfferent fibersEfferent fibersVasoconstriction 234234
Figure 25-4. Innervation of the urinary bladder and its sphincters.
Figure 25-5. Comparisons of normal responses to the tilt (Control) with orthostatic hypotension (OH). Normal heart rate (HR) increment (>10 BPM and < 30 BPM) is seen in both examples. Blood pressure is stable in a healthy control subject. The right panel shows supine hypertension and marked OH during the tilt. Cerebral blood flow velocity (CBFv) is stable in a control subject and reduced in OH. (Modified and with permission from Novak P: Cerebral blood flow, heart rate, and blood pressure patterns during the tilt test in common orthostatic syndromes. Neurosci J 2016:6127340, 2016 (epub).)