Evaluation of patients for autonomic dysfunction should start with a careful review of symptoms. Several symptoms are useful indicators of the possibility of autonomic nervous dysfunction. These symptoms include postural dizziness, lack of sweating, failure of erection or ejaculation, difficulty with emptying the urinary bladder or recurrent urinary tract infections, and dryness of the eyes, mouth or vagina. Table 2 shows the implications for sympathetic and parasympathetic dysfunction in such patients. An infrequently sought symptom in patients with diabetic autonomic neuropathy is gustatory sweating of the face, which reflects parasympathetic denervation. Postprandial hypotension is unlikely to occur except in severe autonomic neuropathies. It results from pooling of blood in the viscera and is aggravated by abrupt standing after meals.
TABLE 2 Symptoms and Signs Suggestive of Autonomic Dysfunction
Failure of pupils to dilate in the dark
Fainting, orthostatic dizziness
Constant heart rate with orthostatic hypotension
Paralysis of dartos muscle
Source: From Ref. 2.
Fixed dilated pupils
Lack of pupillary accommodation
Sweating during mastication of certain foods
Decreased gut motility
Dry eyes and mouth
Difficulty with emptying urinary bladder Recurrent urinary tract infections
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