autonomic dysfunction (dysautonomia)

Introduction

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

Diagnostic procedures

• 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

More general terms

• neurologic disease

More specific terms

• autonomic dysreflexia
• diabetic gastroparesis
• familial dysautonomia; Riley-Day syndrome; hereditary sensory & autonomic neuropathy III
• paraneoplastic sensory neuropathy
• small fiber neuropathy

Additional terms

• autonomic nervous system

Patient information

autonomic dysfunction (dysautonomia) patient information