Evaluating The Patient For Autonomic Symptoms And Signs

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

Sympathetic

Failure of pupils to dilate in the dark

Fainting, orthostatic dizziness

Constant heart rate with orthostatic hypotension

Absent piloerection

Absent sweating

Impaired ejaculation

Paralysis of dartos muscle

Source: From Ref. 2.

Parasympathetic

Fixed dilated pupils

Lack of pupillary accommodation

Sweating during mastication of certain foods

Decreased gut motility

Dry eyes and mouth

Dry vagina

Impaired erection

Difficulty with emptying urinary bladder Recurrent urinary tract infections

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