autonomic system disorders

Question 1

autonomic nervous system

Answer 1

the central and peripheral portions of the nervous system designed to harmonize bodily functions w/ brain state

bp, heart rate, digestion, urination, thermoregulation

2 polarities: rest and digest- parasympathetic, fight or flight-sympathetic

most often coordinate together: cooling (sweating and skin dilation), voiding (detrusor and trigone), fainting (hypotension and bradycardia)

Para sympathetic- cranio sacral control, sympathetic- thoracolumbar

Question 2

autonomic function 2 spinal levels to consider

Answer 2

T6: orthostatic hypotension: splanchnic circulation innervation, at risk for autonomic dysreflexia

S1: upper motor bladder/bowel: lower motor neuron at conus

Question 3

orthostatic hypotension

Answer 3

structural autonomic disorder: lots of findings, hard to elicit, typically denies lightheadedness.

Question 4

structural vs functional disorders

Answer 4

structural–hardware problem, well defined change in ANS structure produces disease: MS atrophy, diabetic autonomic neuropathy, baroreflex failure due to neck radiation

functional– software problems, change in ANS function, produces symptoms, but is less well defined, link in a pathogenic chain, postural tachycardia syndrome, IBS, syncope,

Question 5

harlequin syndrome

Answer 5

Antibody mediated disorder, responded to immunomodulation

Question 6

thermoregulation: model of integration

Answer 6

afferent input: anterior hypothalamus, setpoint control (altered by VIP, IL6, IL2, PGE2)

Activation: anterior hypothalamus–> cooling
posterior hypothalamus–> fever

ascending (behavioral–move to cooler or warmer environment)

Descending path: interomedio lateral horn–> skin vessels, sweat glands, brown fat
anterior horn –> motor (shivering)
Brainstem–> respiratory rate
Anterior pituitary–> thyroid stimulation

Question 7

hypothalamic function/circuit

Answer 7

chief internal environment operating officer

Through neural networks (Up–> behavior and Down)

Question 8

hypothalamic lesions

Answer 8

Suprachiasmatic nucleus(ant region): function (regulates circadian rhythm), lesion (insomnia), neurons lost in alzheimers disease, shift work

Anterior nucleus (ant region): function (dissipates heat), lesion (hyperthermia), endogenous pyrogens (IL2, PGE2) cause fever

Medial hypothalamus: regulates behavior (stop overeating), lesion causes overeating leads to obesity, prader willi syndrome (craniopharyngioma)

Question 9

Periaqueductal gray

Answer 9

chief external environment operating officer: Responds to CEO= ventro medial prefrontal cortex, CFO= insula (the bean counter), COO= amygdala (provides urgency) , collaborates with cheif internal environment operating officer (hypothalamus)

Function: implements basic behavioral mode Safe/threat