Autonomic

Autonomic Dysfunction

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Autonomic Dysfunction, Dysautonomia, Autonomic Neuropathy, Chronic Autonomic Neuropathy

  • Types
  • Chronic Autonomic Failure
  1. Orthostatic Hypotension
    1. See Autonomic Dysfunction
    2. See Autonomic Neuropathy
    3. Diabetes Mellitus
    4. Amyloidosis
    5. Tabes Dorsalis (Syphilis)
    6. Multiple Sclerosis
    7. Acute Intermittent Porphyria
    8. Guillain-Barre Syndrome
    9. Connective Tissue Disorders
    10. Spinal Cord Injury
    11. Toxins
      1. Vacor rat poison
      2. Arsenic
      3. Mercury
    12. Renal Failure with Uremia
    13. Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
    14. Wernicke Encephalopathy (chronic Alcohol Abuse)
    15. Medication Causes of Orthostatic Hypotension
  2. Primary Chronic Autonomic Failure (Idiopathic)
    1. Pure autonomic failure
    2. Multiple system atrophy (e.g. Shy-Drager Syndrome)
    3. Parkinson's Disease (or Lewy Body Dementia)
  3. Riley-Day Syndrome (Familial Dysautonomia)
    1. Peripheral and central degenerative disorder
    2. Decreased Lacrimation
    3. Transient skin blotching
    4. Episodic Hypertension
    5. Episodic fever
    6. Vomiting
    7. Altered Taste discrimination
    8. Decreased sensitivity to pain
    9. Emotional lability
  4. Chronic Orthostatic Intolerance
    1. Example: Neuropathic postural Tachycardia syndrome
  5. Hirschprung's Megacolon
    1. Congenital absence of parasympathetic Ganglion cells in colon wall
    2. Results in decreased colon motility, Constipation and a significantly dilated colon
  6. Other causes
    1. Panic Disorder (psychogenic Ischemic Heart Disease)
    2. Neurogenic Essential Hypertension
    3. Congestive Heart Failure
    4. Chronic Fatigue Syndrome
  • Findings
  • Symptoms and Signs
  1. Postural Hypotension
  2. Nocturnal Diarrhea
  3. Impotence
  4. Incomplete voiding
  • Diagnostics
  • Telemetry monitoring
  1. No overshoot Tachycardia on standing
  2. No variation in pulse with Valsalva Maneuver
  3. No Blood Pressure (<10 mmHg) increase with hand grip
  1. See Vasovagal Syncope for assessment and management
  • References
  1. Goldberg (2014) Clinical Physiology, p. 104-5
  2. Pryse-Phillips in Noble (2001) Primary Care, p. 1599
  3. Saper in Goldman (2000) Cecil Medicine, p. 2057-8
  4. Goldstein (2002) Ann Intern Med 137:753-63 [PubMed]