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autonomic dysfunction (dysautonomia)
Dysfunction of the autonomic nervous system.
Clinical manifestations:
- symptoms variable
- orthostatic hypotension, often with inadequate heart rate response to standing
- blood pressure fluctuation: hypertension or hypotension
- abnormal hemodynamic responses to pharmaceutical agents
- cardiac arrhythmias
- tachycardia or bradycardia
- dyspnea
- peripheral vasoconstriction
- abnormal control of sweating: hyperhidrosis/diaphoresis or decreased sweating
- cool, pale, hyperhydrotic, cyanotic skin
- warm, red, dry skin
- flushing or pallor
- hyperpyrexia
- generalized capillary dysfunction in all fingers & toes rather than in nerve or dermatomal distribution
- paresthesias
- pupillary dysfunction
- diplopia
- ptosis (uncommon)
- GI dysfunction, constipation
- sialorrhea or dry mouth
- urinary retention
- erectile dysfunction
Laboratory:
- serum glucose & HgbA1C
- vitamin B12 in serum
Special laboratory:
- electromyography
Complications:
- pneumonia
- respiratory failure
- cardiopulmonary arrest
Management:
- treatment is symptomatic & supportive
- treat orthostatic hypotension
- elevation of the head of the bed
- frequent small meals
- high-salt diet
- pharmaceutical agents
- fludrocortisone, midodrine, ephedrine
- prognosis
- patients with chronic, progressive, generalized dysautonomia in the setting of central nervous system degeneration have a poor long-term prognosis
Related
autonomic nervous system
Specific
autonomic dysreflexia
diabetic gastroparesis
familial dysautonomia; Riley-Day syndrome; hereditary sensory & autonomic neuropathy III
paraneoplastic sensory neuropathy
small fiber neuropathy
General
neurologic disease
References
- Medical Knowledge Self Assessment Program (MKSAP) 17, 18.
American College of Physicians, Philadelphia 2015, 2018.
- NINDS Dysautonomia Information Page
https://www.ninds.nih.gov/Disorders/All-Disorders/Dysautonomia-Information-Page