Autonomic disorders Flashcards
1
Q
what is a sign of advanced autonomic failure?
A
orthostatic hypotension
2
Q
which is more important for autonomic disorders - history or tests?
A
history
3
Q
orthostatic hypotension: definition
A
- drop in BP related to change in position
- 20 mm Hg in SBP
- 10 mm Hg in DBP
- increase in pulse by 20
4
Q
how is orthostatic hypotension assessed?
A
- check BP and pulse after supine to standing: immediately, 1, and 3 minutes
- check HR response (BP and pulse)
want to be sensitive and pick up an abnormality
5
Q
what are the first line medications for orthostatic hypotension?
A
- fludrocortisone
- midodrine (alpha adrenergic agonist - most popular)
- EPO
- oral or nasal vasopressin analogs
6
Q
what are the features of MSA (multi system atrophy)? what is the other name for it?
A
AUTONOMIC FAILURE OF:
- orthostatic hypotension
- impotence
- bladder and bowel dysfunction
- reduced sweating
- parkinsonism
- cerebellar dysfunction
- aka Shy-Drager syndrome
7
Q
which autonomic symptom is sometimes seen in patients with guillain barre syndrome?
A
- tachyarrythmia / arrhythmia
8
Q
what are the features of acute autonomic neuropathy? what condition does it mimic?
A
- pandysautonomia rapidly with progression over weeks
- difficult diagnosis if symptoms not recognized as autonomic
- elevated CSF protein
- guillain barre syndrome
9
Q
what are the autonomic manifestations of diabetic autonomic neuropathy?
A
- orthostatic hypotension
- GI symptoms
- bladder dysfunction
- sudomotor dysfunction (dry, cold, shiny hairless distal skin)
10
Q
what is POTS? what are the features?
A
- postural orthostatic tachycardia syndrome
- postural related tachycardia
- sympathetic activation (lightheadedness, fatigue, weakness)
11
Q
how is hyperhydrosis usually treated?
A
botox
