Red flags: Autonomic dysfunction Flashcards
What are features of trigeminal autonomic dysfunction (TAGs)?
cranial parasympathetic activation
- conjunctival injection/ lacrimation
- rhinorrhea
- nasal congestion
- eyelid edema
- aural fulness
sympathetic hypofunction
- forehead and facial sweating/ flushing
- voice changes
- throat swelling
- miosis/ ptosis
Second -order preganglionic pathologies in the thoracic cavity!
-Breast or lung cancer
- mediastinal masses
- chest surgery
- thoracic aortic aneurysms
- surgical lesions
- central vascular access
- trauma apical lung lesion
- non-small- cell lung lesion
- tumors
- metastatic disease
- infection
Symptoms mimicking MSK dysfunction:
- TOS ( peripheral NS signs including hyporeflexie, hypesthesia, atrophy, paresis), venous-lymphatic signs: edema, reduced arterial flow (skin and nail trophism, pallor), shoulder- and arm pain.
Second -order preganglionic pathologies in the cervical sympathetic chain
- neuroblastoma
- schwannoma
- neuroectodermal tumor
- vagal paraganglioma
- mediastinal tumors
- cysts
Symptoms: TOS symptoms AND fever, respiratory signs! ( typical Pancoast as signs)
Second- order preganglionic pathologies: Neck
- cervical rib
- trauma
- abscess
- tumor
- lymphadenopathy
- thyroid neoplasms
- thyroidectomy
- radical neck surgery
- central vascular access
Symptoms:
TOS symptoms
Third -order post-ganglionic pathologies, superior cervical ganglion
By trauma, jugular venous dilation, neck surgery, penetrating intraoral injury, tonsillectomy,
Symptoms: neck pain, facial pain, headache, stroke- like symptoms, ocular ischemia, cerebral ischemic symptoms, aphasia, apraxia, hypoacusia, cognitive impairments, contralateral hypesthesia,
Third -order post-ganglionic pathologies, carotid artery
same symptoms as for superior cervical ganglion possible!!
Horner syndrome
important red flag
- damage to the oculosympathetic pathway, most often pre-, or post-ganglionic lesions, both approx. 45%.
Most frequent post -ganglionic: CAROTID DISSECTION!!!
Features:
-ptosis
- anisocoria (difference in pupil size) like miosis (smaller pupil in the affected eye)
- ipsilateral anhidrosis (lack of perspiration)
Anisocoria
Test for the size of pupils
parasympathetic: makes the pupil smaller!
sympathetic: makes the pupil larger
Test in both bright light and darker
In Horner, usually darker environments be, as dilation is sympathetic!
A greater anisocoria in BRIGHT light indicates parasympathetic deficiency! Usually CN III!
Pancoast tumor
Tumor(s) located at the apical pleuro-pulmonary groove, SUPERIOR TO THE FIRST RIB
Symptoms:
- shoulder pain, arm pain, neck pain, paresthesia, paresis AND THENAR MUSCLE ATROPHY!!
AND Horner sign
Ross syndrome
Rare condition, progressive
Symptoms:
- anhidrosis/ hypohidrosis
- areflexia
- tonic pupils
Differ from Holmes - Adie by
HEAT INTOLERANCE
Harlequin syndrome
rare, benign
- hemifacial anhidrosis
- initially hemifacial flushing
- later: compensatory flushing and hyperhidrosis controlateral
- “only” focal anhidrosis (above the eyebrow) indicates involvement of third-order neurones, travelling with the internal carotid artery!
can be a first sign of
- Guillane-Barré, diabetic neuropathy, MS and others
Holmes- Adie syndrome
Common syndrome
reversed Horner
Pupillotonia
- damage of the ciliary ganglion
Symptoms:
- vasomotor and sudomotor
- tonically dilated pupils, sometimes bilateral
- weak or unresponsive light reflex
- but: strong and tonic response to near point stimulation!
- deep tendon areflexia, most commonly Achilles tendon!
DD: syphillis, herpes or Guillane-Barré show also TONIC PUPILS!
