Autonomic dysfunction

Meyer S, Strittmatter M, Fischer C, Georg T, Schmitz B. Lateralization in autonomic dysfunction in ischemic stroke involving the insular cortex. Neuroreport 2004 15(2) 357-361. 

Preventive measures for patients who may be prone to hypotension include accurate determination of the dry weight and maintaining a constant ultrafiltration rate. Midodrine is an a-adrenergic agonist that is effective in reducing hypotension in patients with autonomic dysfunction that is taken with each dialysis session or as chronic therapy. Midodrine can be administered at doses of 2.5 to 10 mg prior to HD or 5 mg twice daily for chronic hypotension. Side effects of midodrine include pruritus and paresthesias. 

The treatment of non-motor symptoms, such as psychological conditions, sleep disorders, and autonomic dysfunction, should include both pharmacologic and nonpharmacologic approaches. Patients should be given suggestions for maintaining ADLs, a positive self-image, family communication, and a safe environment. 

Extrinsic Neuropathies. Autonomic dysfunction [141], pandysautonomia [142,143], Shy-Drager syndrome [144] and sympathetic dysfunction are conditions associated with intestinal dysmotility. 

Bharucha AE, Camilleri M, Low PA, Zins-meister AR Autonomic dysfunction in gastrointestinal motility disorders. Gut 1993 34 397-401. 

Low, P. A., Vernino, S. and Suarez, G. Autonomic dysfunction in peripheral nerve disease. Muscle Nerve 27 646-661, 2003. 

Antibodies cause calcium channel dysfunction in Lambert-Eaton syndrome. Some patients with cancer, especially small-cell carcinoma of the lung, develop a syndrome of weakness associated with autonomic dysfunction as part... 

Symptoms develop rapidly over 24 to 72 hours and include body temperature exceeding 38°C (100.4°F), altered level of consciousness, autonomic dysfunction (tachycardia, labile blood pressure, diaphoresis, tachypnea, urinary or fecal incontinence), and rigidity. 

Hofstra, R. M. W., Valdenaire, O., Arch, E., et al. (1999) A loss-of-function mutation in the endothelin-converting enzyme 1 (ECE-1) associated with Hirschsprung disease, cardiac defects, and autonomic dysfunction. Am. J. Hum. Genet. 64, 304-308. 

ABP is clinically most useful in patients with suspected white-coat hypertension . It is also helpful in patients with apparent drug resistance, hypotensive symptoms with antihypertensive agents, episodic hypertension and autonomic dysfunction. However, this procedure should not be used indiscriminately, such as in the routine evaluation of patients with suspected hypertension. 

CFS patients and is related to autonomic dysfunction. In a separate rat study, Giannesini et al. used citrulline malate (CM) to treat asthenia and found that the supplementation prevented the basal PCr/ATP ratio reduction and normalized the pHi time-course during muscular activ-ity. They conclude that CM supplementation corrects the impaired control of oxidative function and has protective effect on basal energy metabolism. The data from either human or animal studies provide a potential approach to therapy. 

The common denominator was the patients ability to attend appropriately to a given task. Further, attentional dysfunction, information-processing impairment, and autonomic dysfunction were improved more in the drug-treated group. 

The Swiss biochemist Albert Hofmann discovered the hallucinogenic effects of LSD-25 by accident when he was working to synthesize molecules akin to ergota-mine for the treatment of peripheral autonomic dysfunction. In a rush of what scientists call serendipity (or chance discovery) Hofmann realized that he had stumbled upon a far more important effect LSD acted in the brain itself, altering its chemistry in the direction of psychosis and of dreaming. Descriptions of these effects upon his mind are given in the text. (Courtesy of the Albert Hofmann Foundation)... 

Diabetic neuropathy may be associated with neuropathic ulcer, ptosis, diplopia, strabismus, loss of deep tendon reflexes, ankle drop, wrist drop, paresthesia, hyperalgesia, hyperesthesia, and orthostatic hypotension (because of autonomic dysfunction). 

Chaudhuri KR. Autonomic dysfunction in movement disorders. Curr Opin Neurol 2001 14 505-511. 

Regarding the NE system, loss of neurons in the LC and the existence of Lewy bodies have been shown by analysis of post mortem brains of PD patients (Zarow et ah, 2003) (Hoogendijk et ah, 1995) (Jellinger, 1991) (Chan-Palay and Asan, 1989). Reduced levels of NE in addition to disturbances in other related neurotransmitter system like the serotonergic may account for clinically relevant symptoms like depression, dementia, sleep disorders and autonomic dysfunction seen in PD. 

PEM is one of the most frequent cancer-associated syndromes. This complex disorder usually affects several areas of the CNS. Cerebellar and brain stem disorders, as well as limbic encephalitis, are the most common clinical presentations of PEM [31, 32], Focal involvement of the sensorimotor cortex has been described in a few cases [33], and PEM may manifest as epileptic seizures or epilepsia partialis continua [33, 34], or as extrapyramidal symptoms [35], Two-thirds of the patients are affected in both the CNS and the peripheral nervous system. The predominant feature in more than half of these is SN [32, 36], hence the commonly used term is PEM/SN. Autonomic dysfunction is common in PEM/SN patients [36], often presenting as gastrointestinal dysmotility [37]. 

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],... 

Finally, autonomic dysfunction is a common feature of LEMS with and without malignant disease. In LEMS patients, the most frequent symptoms are cholinergic, including dry mouth, erectile failure, constipation, blurred vision, and impaired sweating, suggesting that major involvement is the parasympathetic nerves [109]. 

O Suilleabhain P, Low PA, Lennon VA. Autonomic dysfunction in the Lambert-Eaton myasthenic syndrome Serologic and clinical correlates. Neurology 1998 50(1)88-93. 

A 53-year-old man developed atypical neuroleptic malignant syndrome, with fever, altered mental status, and autonomic dysfunction, but without rigidity (a usual feature of this condition) while taking olanzapine (109). 

Merz, B., Bigalke, H., Stoll, G., Naumann, M. (2003). Botulism type B presenting as pure autonomic dysfunction. Clin. Auton. Res. 13 337-8. 

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. 

Verne, G.N., Soldevia-Pico, C., Robinson, M.E., Spicer, K.M., Reuben, A. Autonomic dysfunction and gastroparesis in cirrhosis. J. Clin. 

Anthracyclines can cause the late complication of a cardiomyopathy, which can be irreversible and can proceed to congestive cardiac failure, ventricular dysfunction, conduction disturbances, or dysrhythmias several months or years after the end of treatment (3,4). Doxorubicin can cause abnormalities of right ventricular wall motion (5). A significant number of patients receiving anthracyclines develop cardiac autonomic dysfunction (6). 

Carbamazepine-induced renal insufficiency has been described, but has not been firmly documented (SEDA-18, 63). Two diabetic patients who developed urinary retention on low doses (400-600 mg/day) were confirmed by rechallenge there have been earlier reports, and pre-existing autonomic dysfunction may be a predisposing factor (54). 

Clonidine-induced hypertension has been reported in a patient with autonomic dysfunction (10). 

A 39-year-old quadriplegic man with poorly controlled pain had many features consistent with autonomic dysfunction (for example a C4 spinal lesion, orthostatic hypotension, hypertension). He routinely used trans-dermal clonidine and transdermal glyceryl trinitrate as needed for control of acute hypertensive episodes. The clonidine was discontinued, after which his blood pressure fell (maximum systolic and diastolic pressures by about 50 and 25 mmHg respectively). 

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