Autonomic Disorders

BACKGROUND– Autonomic complications may result from many central and peripheral nervous system conditions. Understanding the anatomy and the spectrum of presentations of autonomic neuropathy is crucial to its recognition and management. REVIEW SUMMARY– This study will review the anatomy of the parasympathetic and sympathetic systems, describe the appropriate history and physical examination to be performed in a patient with suspected autonomic dysfunction, and list disorders that give rise to autonomic failure. Within the context of the autonomic physical examination, the measurement of positional blood pressures and bedside techniques for the detection of autonomic failure will be stressed. Most emphasized will be three easily performed electrophysiologic procedures that quantify the integrity of the parasympathetic and sympathetic output. Their use can be helpful in verifying the presence of autonomic dysfunction and serially following the response to therapy. The discussion of treatment will primarily focus on lifestyle changes and pharmacologic approaches to the management of orthostatic hypotension, neurogenic bladder, sexual dysfunction, and gastrointestinal disorders. CONCLUSIONS– The diagnosis and management of autonomic disorders require a knowledge of the anatomy, physiology, and pharmacology of the autonomic nervous system and the array of the central and peripheral neurologic disorders that give rise to autonomic symptoms and signs. Laboratory testing of the autonomic nervous system substantiates the presence of autonomic dysfunction and can be used to monitor disease progression or improvement after therapy.