Autonomic nervous system dysfunction/Dysautonomia
Autonomic dysfunction can be primary or secondary to many disease processes. Dysautonomia refers to the many conditions in which the ANS dysfunctions.
Manifestations of autonomic dysfunction – impotence; bladder dysfunction; GI dysfunction; orthostatic hypotension
Manifestations of autonomic neuropathy in the lower limb:
• hyperhidrosis (overactivity)
• anhidrosis (if disruption in autonomic system)
• Raynaud’s phenomenon (overactivity of sympathetic vasoconstrictors)
Valsalva manoeuvre – supine blood pressure and heart rate after 5-10mins of rest, then again after 2mins of standing – should not drop >30mmHg; if does drop indicative of autonomic neuropathy.
heart rate variability with breathing
tests of sweating (Quantitative Sudomotor Axon Reflex Test – QSART)
Diabetic autonomic neuropathy: