Autonomic disturbances

The neuroleptic malignant syndrome is characterized by hyperthermia (temperature over 103 °F without evidence of infection), altered sensorium, muscle rigidity, and autonomic disturbances, usually profuse diaphoresis, hypersali vat ion, bronchorrhea, and urinary retention. 

Motor and autonomic disturbances are less common in this group than in any of the major patterns. Severe hypertension has been noted. Rhabdomyolysis is unusual. 

DAM-57, N,N-Dimethyllysergamide. This compound did induce autonomic disturbances at oral levels of some ten times the dosage required for LSD, presumably in the high hundreds of micrograms. There is some disagreement as to whether there were psychic changes observed. 

The SN often associated with the Hu antibody is characterized by primary damage to the nerve cell body. The patient suffers from progressive, painful sensory disturbances evolving subacutely, usually with a Rankin score of 3 within 12 weeks of the onset of symptoms [14]. Presenting symptoms include paresthesia, hypoestesia, and very often proprioceptive loss in the affected areas sensory ataxia is common. The upper limbs are often involved [97], The distribution of the SN is often atypical for peripheral neuropathy. The involvement is usually asymmetrical, especially at the onset of symptoms, and may affect the face or upper limbs only. SN is often the presenting symptom of the PEM/SN syndrome, but signs of CNS involvement usually evolve, and autonomic disturbances are common [36]. 

Paraneoplastic autonomic neuropathy is primarily seen with SCLC [103]. Lymphoma, non-small cell lung cancer, and ovarian cancer are also associated with autonomic disturbances [104]. Autonomic dysfunction affects 23-30% of Hu antibody positive patients [36, 98] and is the predominant symptom at presentation in up to 9% of the patients [90]. The onset of symptoms is usually subacute. A prominent clinical manifestation in patients with paraneoplastic autonomic neuropathy is gastrointestinal dysmotility and intestinal pseudo-obstruction, which can occur as part of the PEM/SN syndrome or as the sole symptom of Hu antibody related PNS. Ortostatic hypotension and erectile dysfunction are other common features [37, 105, 106], Autonomic neuropathy is also commonly associated with the CRMP-5 antibody and have been detected in more than 30% of CRMP-5 antibody positive patients [30], Inflammation in autonomic ganglia and infiltration of B and T cells have been demonstrated at autopsy [107], and Hu antibodies have been shown to induce neuronal apoptosis in cultured myenteric neurons [105],... 

Tetanus toxin often causes disturbances in autonomic control, resulting in sympathetic overactivity and high plasma catecholamine concentrations. The first-line treatment for autonomic dysfunction is by sedation with a benzodiazepine and opioid. Infusion of the short-acting i-blocker esmolol, or the o -adrenergic agonist clonidine, helps to control episodes of hypertension. Intravenous magnesium sulphate is also used to reduce autonomic disturbance. 

GBS may progress up to 4 weeks with a nadir being reached within 2-3 weeks in a majority of patients. Recovery usually begins within 2-A weeks of this nadir, but can be delayed for several months. About one-half of patients become chair- or bed-bound, one-third require intensive care admission, and one-quarter mechanical ventilation (Winer et al., 1988 Rees et al., 1998 Hughes and Comblath, 2005). Functional recovery is a rule and occurs in a majority of patients over 6-12 months however 20-30% of patients are left with significant disability and about 10% require assistance with walking. The mortality rate ranges between 3 and 8%, and most deaths are attributed to cardiac arrest due to autonomic disturbance, respiratory failure or infection, or pulmonary embolism. 

The authors believed that symptoms in this case resembled the neuroleptic malignant syndrome, based on the combination of muscle rigidity, pyrexia, signs of autonomic disturbance, and altered consciousness. They did not think that the raised serum creatine kinase activity was associated with rhabdomyolysis. 

B. Neubauer and H. J. G. Gundersen, Analysis of heart rate variations in patients with multiple sclerosis. A simple measure of autonomic disturbances using an ordinary ECG. J. Neurol. Neuosurg. Psychiatry 41, 417—419 (1978). 

Peripheral neuropathies are common neurological disorders that result from damage to the peripheral nerves (Pascuzzi, 2003). The peripheral nerves represent the nerves outside the brain and spinal cord and consist of motor, sensory, and autonomic nerve fibers. Depending on the fiber classes affected, neuropathies are subdivided into motor, motor and sensory, and pure sensory forms. In addition, autonomic disturbances may be present leading to the additional classification into autonomic or autonomic and sensory neuropathies. 

Patients with sensory neuropathies often exhibit dry and fissured skin pointing to additional autonomic disturbances. Sometimes the skin is moist and of red-bluish color (glossy skin) because of the wide opening of small vessels owing to paresis of autonomic nerves. 

Besides the cardinal symptoms in PD, many autonomic disturbances, such as hypotension, hypersalivation and constipation, which are a part of a parkinson-plus syndrome, are present and also can be attenuated by DOPA-application (Guttman and Seeman, 1986). Therefore, it can be suspected that these symptoms also result from a central DA deficiency, perhaps related to the observed biochemical effects on DA-containing centers in the hypothalamus and area postrema. 

A growing number of autonomic disturbances of orthostatic regulation have been identified. The systan in Fig. 13.1 follows that developed by the American Autonomic Society and attempts to represent current understanding of these disorders in a clinically nseful framework (12). 

Grubb BP, Karas BJ The potential role of serotonin in the pathogenesis of neu-rocardiogenic syncope and related autonomic disturbances. J. Intervent. Cardiac... 

Autonomic disturbances that affect autonomic innervation... 

Autonomic disturbances are frequent with L-dopa, and while long-term oral therapy [449] can resemble intravenous administration [468] in producing hypertension, it is much more common for postural hypotension to be produced [5, 6a, 450-461, 468, 470]. The symptoms normally clear when the dose is reduced, and it is possible to re-establish the patient on higher doses... 

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