P year‎ > ‎Neurology‎ > ‎

12.11.13 Autonomic dysfunction

Conditions
  • Acute
    • GBS
      • DANGEROUS! Watch out
  • Chronic
    • Diabetes
    • Parkinsonism (multi-system atrophy)
    • Shy-Drager syndrome

Symptoms
  • CVS
    • Postural dizziness
  • GI
    • Upper - Vomiting
    • Lower - Nocturnal diarrhoea
  • Sweating
    • Gustatory, in response to tyramines
  • GUS
    • Erectile dysfunction (early sign)
    • Trouble voiding


Examination

  • Pulse
    • < 20 BPM change after 6 deep breaths
    • < 15 BPM change after standing
  • BP
    • > 15/10 mmHg postural drop
      • But wait 3 MINS before measuring
      • Keep arm at heart level
  • ECG RR ratio
    • Changes after valsava (breathe into manometer + maintain 40 mmHg pressure)


Postural hypotension management

  • Conservative
    • Sit on bed for 3 mins before standing
    • Fluids (3 L per day)
    • Salt
    • Stockings
    • Sleep head-up
    • Physical countermeasures
      • Buttock tensing
      • Stand on toes
      • Tense arms and shoulders
  • Medication
    • Fludrocortisone
      • But keep an eye on [Na]
    • Alpha agonist
      • Midodrine
    • Erythropoietin

Gaits
  • Cerebellar
    • Wide-based
    • Drunken
    • With slurred speech
  • Stroke
    • Circumduction
  • Spastic paraparesis
    • Stiff knees
  • Parkinsons
    • Shuffling
    • Fenestrating (accelerating)
  • Foot slap (common peroneal palsy)
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