disorders of ANS

Nivedita Mpt (Neuro)

• The autonomic nervous system (ANS) is a subcomponent of the
peripheral nervous system (PNS) that regulates involuntary
physiologic processes, including blood pressure, heart rate,
respiration, digestion, and sexual arousal.
• It comprises sympathetic, parasympathetic, and enteric nervous
systems
Autonomic dysfunction can occur as a result of many diseases that
affect autonomic pathways
Autonomic nervous system functions
• Perfusion of the whole body through regulation of heart rate and
blood pressure
• Homoeothermic role through sweating control and shivering,
• Processing of nutrients through control and coordination of different
parts of the gut and glands,
• Urinary motility, and
• Pupil movement, focusing, and lacrimation.
etio
Inherited
• hereditary sensory autonomic neuropathy,
• Genetic disorders like familial dysautonomia
Acquired
• Autoimmune: Guillain-Barre,Lambert-Eaton myasthenic syndrome,
rheumatoid arthritis, systemic lupus erythematosus
• vasovagal syncope
• Metabolic/ Nutritional: Diabetes mellitus, vitamin B12 deficiency
• Degenerative neurologic diseases: Parkinson disease
• Infections: HIV, leprosy, tetanus
• Brain tumors
• Toxin/drug-induced
• Traumatic or spinal cord injuries (autonomic dysreflexia)
• Uremic neuropathy/chronic liver diseases
pathophy
• A central degenerative disease process involving preganglionic
neuronal degeneration, presenting with orthostatic hypotension and
typical parkinsonian symptoms,
• Autonomic dysfunction may result from any disease that affects the
peripheral or central components of ANS.
• Primary autonomic dysfunction involves primary (idiopathic)
degeneration of autonomic postganglionic fibers without other
neurologic abnormalities.
clinical features
the usual orthostatic symptoms consist of lightheadedness,
• visual blurring or tunnel vision,
• neckache,
• nausea,
• palpitations, tremulousness, weakness, and dizziness.
• Other symptoms include exercise intolerance, fatigue, shortness of
breath, chest pain, anxiety, hyperventilation, concentration difficulty,
and headaches.
• Orthostatic intolerance
• “Coathanger” headache
• Near-syncope and syncope
Genitourinary
• Bladder urgency or frequency
• Incontinence
• Nocturia
Gastrointestinal
• Diarrhea
• Constipation
• Fecal incontinence
• Postprandial fullness, cramping, or bloating
• Hyperhidrosis/ Hypohidrosis/anhidrosis
investigations
• history and comprehensive examination of cardiovascular, urinary,
neurological, and sudomotor manifestations
• Tilt Table Test
• heart rate (while supine and after three minutes standing)
• Vesical ultrasonography
management
• exercise program
• pressure stockings
• autoimmune diseases- intravenous immunoglobulins, and plasma
exchange
symptomatic neurogenic orthostatic hypotension:
• alpha-adrenergic agonist and
• norepinephrine precursor