Autonomic Disorders Flashcards
What is the hx of Non-neurogenic orthostatic hypotension?
- Dimming of vision
- Dizziness or lightheadedness
- Sweating
- Pallor
- Paroxysmal weakness
- Loss of consciousness
What do pt w/ non-neurogenic orthostatic HOTN frequently have?
- Hx of HTN or heart dz
- Take meds that cause orthostatic HOTN
What is Orthostatic HOTN?
Drop in systolic BP of >20mmHg d/or a drop in diastolic BP >10mmHg w/in 3min of standing from a supine position. Compensatory inc in pulse rate of >15 BPM
What is the cause of Orthostatic HOTN?
Reduction in perfusion to the brain upon standing resulting in sx
What is the tx of Orthostatic HOTN?
- Meds adjustment
- Correct hypovolemia
- Exercise
- Correct anemia
Who gets Orthostatic HOTN assoc w/ brain disorders?
Older adults
What is the duration of orthostatic HOTN assoc w/ brain disorders?
Subacute or chronic
What is the hx of orthostatic HOTN assoc w/ brain disorder?
- Neuro sx
- Parkinsonian-like sx freq
- Cerebellar dysfxn
- Other autonomic sx
- CNS disturbances
What are Autonomic sx?
- Diarrhea
- Constipation
- Urinary retention
- ED
- Sweating disturbances
What are the CNS distrubances?
- Language
- Memory
- Speech
- Swallowing
What are the PE findings of orthostatic HOTN w/ brain disorders?
- Orthostatic HOTN
- No compensatory in in HR
- Neuro findings suggestive of CNS distrubance
What are the neuro findings of CNS distrubances?
- ABN of muscle tone
- Ataxia
- Tremor
- ABN pupillary light reflexes
- Gait disorder
What are the tech findings of orthostatic HOTN w/ brain disorder?
ABN autonomic testing
ABN findings on brain MRI
What is the tx of orthostatic HOTN w/ brain disorders?
- Check meds
- Hydration
- Exercise as tolerated
- Libral salt
- Alpha sympathetic agonist
- Pressure hose to promote venous return to the hear
What are the hx/sx of orthostatic HOTN assoc w/ peripheral nerve dysfxn?
- Stocking glove sensory disturbances
- Peripheral weakness
- Autonomic sx
What are the tech features of orthostatic HOTN assoc w/ peripheral neuropathy?
ABN autonomic testing
What causes orthostatic HOTN assoc w/ peripheral neuropathy?
Post-ganglionic autonomic fibers PNS are subject to same dz processes that motor & sensory fibers subject to
What are the PE findings of Horner’s synd?
- Ptosis
- Miosis
- Anyhdrosis
What are the sx of ANS disturbance?
- Anhydrosis
- Orthostatic hypotension *MC!
- ABN pupillary reflexes
- Dec lacrimation/salivation
- ED
- Bowel/bladder dysfunction
What is the craniosacral ANS?
PNS
What is the thoracolumbar ANS?
SNS
How does the SNS innervate the pupil?
SC→ sympathetic chain ganglion→Post ganglionic fibers→ Dilator pupillae→ DILATE
How does the PNS innervate the pupil?
CN III→ ciliac ganglion→ short ciliary n.→ciliary muslce of the pupil→ CONSTRICT
What muscle raises the eyelid?
Muller’s muscle innervated by the SNS
What are the peripheral PNS fibers vulnerable to?
COMPRESSION
(Hematoma, herniation, tumor, abscess)
What are the interior PNS fibers vulnerable to?
ISCHEMIA
(supplied by perforating BV)
What causes mononeuropathy muliplex?
DM, SLE, AI dz
What can cause ptosis?
- Horner’s synd
- CN III lesion
- Myasthenia gravis
- Trauma or post op
- Aging
What can cause ptosis AND affect the pupil?
Horner’s synd & CN III lesion
(NOT MG–afects skm ONLY)
What is the hemodynamic response to standing?
Dec BP & Inc HR
What is the hemodynamic reponse to standing in a hypovolemic state?
BIG dec in BP & BIG Inc in HR
What is the hemodynamic response to standing in autonomic failure?
Big dec in BP & no change in pulse (don’t get reflex tachycardia)
What are the peripheral ANS disorders or Pandyastonia?
- Acute inflammatory neuropathy: GBS
- Diabetic neuropathy
- Amyloidosis
- Acute AI Polyneuropathy: Porphyria
- Tetanus
What is complex regional pain synd?
Injury to a part, long after there has been healing, the patient continues to feel pain in the limb
What drugs can cause orthostatic HOTN?
Amlitryptine (SSRI) & Hydrocholorthiazide
