Lec 53 ANS Flashcards by Anna Cushing

What is a pancoast tumor? what is effect?

tumor in apex of lung

- causes horners syndrome = ptosis, miosis, anhidrosis

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What are 3 common causes of horner’s syndrome

canvernous sinus thrombosis
carotid dissection
pancoast tumor

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What are features of CN 3 palsy?

ptosis
eye down and out
mydriasis [ dilated]

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What is afferent limb of BP control by autonomic?

baroreceptors in heart and blood vessels sense pressure
chemoreceptors in carotid body sense O2/CO2
conveyed via CN 9 + 10 to nucleus of solitary tract

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What is efferent limb of autonomic control of BP? ex. when you first go from lying down to sitting

paraysmpathetic via CN 10 ti heart [decrease firing when you first stand up]
sympathetic to heart [increase HR]
sympathetic to peripheral arterioles [vasoconstriction]

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What causes dysfunction of BP autonomic control? signs?

signs: orthostatic hypotension and syncope

CNS: parkinsons syndromes
PNS: autonomic neuropathy –> diabetes

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Where is body temp regulated from?

preoptic area

- anterior hypothalamus

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Is sweating under sympathetic or parasympathetic control?

sympathetic

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How do sudomotor sympathetics differ from other sympathetics?

postganglionic neurotransmitter is ACh

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What causes anihidrosis [too littel sweating]?

usually focal CNS lesion, neurodegenerative disorder, peripheral neuropathy

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What is hyperhidrosis? two types?

primary focal = excess emotional sweating in hands/feet/axilla

generalized = al overdue to central dysregulation

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What causes generalized hyperhidrosis?

central disorder of hypothalamic set point, medication induced, etc

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What is the function of the insular cortex in the central autonomic network?

primary viscero-motor and sensory cortex

relays through hypothalamus

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What is the function of the amygdala in the central autonomic network?

autonomic output related to emotional response

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What is the function of the anterior cingulate in the central autonomic network?

autonomic response related to goal directed behavior

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What is the function of the hypothalamus in the central autonomic network?

location of homeostatic control
connects to both ANS and endocrine and higher cortical structures
sends autonomic output to brainstem, spinal cord via lateral and PVN
integrates ANS and endocrine responses

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What is the function of the nucleus of the solitary tract in the central autonomic network?

relay for visceral sensory info from CN VII, IX, X

medullary reflexes

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What is function of ventrolateral medulla in central autonomic network?

contains:
nucleus ambiguus = CN IX, X, XI pharynx, larynx, esophagus

dorsal motor nuc of X = parasympathetic to viscera

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What is the efferent sympathetic path from brain?

begins in hypothalamus –> reticulospinal tract –> intermediolateral cell column [T1-L3] –> exit CNS via ventral roots to para or pre-vertebral ganglia to join peripheral spinal nerves

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What is the segmental organization of sympathetic intermediolateral column?

T1-T3 = head
T2-T6 = upper limb and thoracic viscera
T5-T11 = ab viscera
T12-L3 = lower limb and pelvic

What is the parasympathetic efferent bath from brain?

beginins in hypothalamus but divides into cranial and sacral

cranial sources:

edinger-westphal = control pupil constriction
salivatory nuclei = tear + saliva
nucleus ambiguus + dorsal motor nuc of X = supply vagus nerve that supplies all thoracic and ab viscera

sacral:
sacral parasympathetics exit spinal cord via ventral roots

What is horner’s syndrome?

disruption of sympathetics to face presents with:

ptosis, miosis, anhidrosis

What is the path of body sensing blood pooling in lower extremities?

baroreceptors in heart and major vessels sense pressure
chemoreceptors in carotid body sense O2 and CO2 levels
info conveyed via CN IX and X to nucleus of solitary tract
PNS efferents via vagus inhibited = increase HR
SNS effects activated = increase HR AND increase BP via peripheral vasoconstriction

What is the 3-neuron path of sympathetic innervation of pupil?

nerve starts in hypothalamus and descends in brainstem to synapse in intermediolateral colum
preganglionic sympathetics from IML column T1/T2 ascend and synapse in superior cervical ganglion
postganglionic sympathetics innervate pupil dilator muscle

What is sinus arrhythmia?

normal variablity in HR caused by dee breathing inhalation --> increase HR exhalation --> decrease HR

What is effect of parkinsonian disorders on ANS?

causes central ANS dysfunction

What is most common cause of peripheral autonomic neuropathy?

diabetes mellitus

What central autonomic structure regulates body temp?

preoptic area and anterior hypohtalamus

Is sweating under SNS or PNS control?

SNS

What is path of sweating mech?

- sudomotor fibers travel with peripheral somatic nerves to sweat glands, release ACh

What is effect of botulinum toxin on sweating?

prevents ACh release into synapse = inhibits sweating

Coordination of what 4 systems required for normal bowel, bladder, sex function?

1. visceral and somatic afferents entering spinal cord via sacral DRG 2. parasympathetic innervation from sacral cord via pelvic splanchnic 3. somatic innervation from sacral cord via pudendal 4. sympathetic innervation from thoracic cord via hypogastric local inhibitory synapse on PNS efferents relaxes detrusor allowing for accumulation urine

What is function of visceral and somatic afferents in pelvic innervation?

signal bladder distension via stretch receptors

What is function of parasympathetic innervation in pelvic innervation?

relax internal sphincter + bladder contraction | --> urination

What is function of somatic innervation in pelvic innervation?

relaxation external sphincter = voluntary urination

What is function of sympathetic innervation in pelvic innervation?

contract internal urethral sphincter + bladder relaxation = urine retention

What is overflow incontinence?

lower motor neuron problem = flaccid bladder paralysis - - inability to sense when bladder is full; stress/overflow incontinence when bladder fills beyond capacity - effects: urgency, nosturia, UTIs, renal impairment

What is pathophysiology of overflow incontinence? causes?

loss of bladder reflex circuit at S2-S4 due to loss of sensory afferents or loss of pudendal inhibition due to: - S2-S4 anterior horn lesion - cauda equiona, conus medullaris lesion - mononeuropathy of pelvic nerves, pudendal - autonomic sensory small fiber neuropathies [DM] - outflow obstruction = enlarged prostate

What is detrusor hyperreflexia?

UMN lesion, automatic/spastic bladder bladder contracts when it shouldn't and does not coordinate its action with sphincters effects: urge incontinence [spasm at low urine volume], frequency, nocturia

What is pathophys/etiologies of detrusor hyperreflexia?

- disruption sympathetic innervation to bladder --> unopposed parasympathetic action; somatic reflex at S2-S4 still intact due to: - spinal cord injury > S2 - CNS lesion [MS, stroke] - detrusor instability

What is difference in time frame of autonomic symptoms parkinsons disease vs parkinsons like disease?

parkinsons disease = late ANS dysfunction | parkinsons-like [shy-drager] = early ANS dysfunction

What is QSART test?

quantititaive sudomotor axon reflex test | release ACh onto skin, measure sweat response

How do you tell syncope vs seizure?

syncope = almost always positional (shortly after standing up or prolonged standing) seizure = metabolic trigger, prodrome = stereotyped, visual or olfactory auras, convulsions, incontinence, postictal confusion

What are common causes of syncope?

need to rule out cardiac cause neurodegenerative: parkinsons [PD] and associated or autonomic neuropathy benign: neurocardiogenic [vasovagal] syndromic: postural orthostatic tachycardia syndrome (POTS)

What is orthostatic hypotension? cause?

- due to neruodegenerative disorder, hypovolemia, autonomic neuropathy - positional hypotension with compensatory tachycardia - other tests of autonomic dysfunction are also abnormal

What is vasovagal syncope? cause?

the common faint due to sudden increase in vagal tone - have bradycardia and hypotension

What is POTS [postural orthostatic tachycardia syndrome]?

- dizziness, fainting upon standing and tachycardia WITHOUT change in BP - more common in young women, post-viral, migraine associated, fibromyalgia - all other tests normal

What are 3 central causes of ANS dysfunction?

multiple system atrophy [Shy-Drager] = early dysfunction parkinsons disease = late dysfunction neuro-degeneration of pure autonomic only