Autonomic Neuropathies

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Chapter 607 Autonomic Neuropathies

Involvement of small, lightly, or unmyelinated autonomic nerve fibers may be seen in many peripheral neuropathies; the autonomic manifestations are usually mild or subclinical. Certain autonomic neuropathies are more symptomatic and demonstrate varying degrees of involvement of the autonomic nervous system regulation of the cardiovascular, gastrointestinal (GI), genitourinary, thermoregulatory, sudomotor, and pupillomotor systems.

The differential diagnosis is noted in Table 607-1. Autonomic nervous system functional tests are noted in Table 607-2. The general treatment of acquired autonomic dysfunction includes treating the primary disorder (systemic lupus erythematosus, diabetes) and long-term management of specific organ system manifestations (Table 607-3). Acute fluctuations of autonomic symptoms may be seen in Guillain-Barré syndrome. Rapid fluctuations of hypertension or tachycardia changing to hypotension or bradycardia should be managed carefully and with very short-acting medications.

Table 607-2 AUTONOMIC FUNCTION TESTING

Sympathetic and parasympathetic divisions of the autonomic nervous system are involved in all tests of autonomic function

CARDIAC PARASYMPATHETIC NERVOUS SYSTEM FUNCTION

SYMPATHETIC ADRENERGIC FUNCTION

SYMPATHETIC CHOLINERGIC FUNCTION

From Freeman R: Autonomic peripheral neuropathy, Lancet 365:1259–1270, 2005.

Table 607-3 MANAGEMENT OF AUTONOMIC NEUROPATHIES

PROBLEM TREATMENT
Orthostatic hypotension
Gastroparesis Prokinetic agents (metaclopramide, domperidone, erythromycin)
Hypomotility Fiber, laxatives
Urinary dysfunction Timed voiding; bladder catheterization
Hyperhidrosis