Autonomic Disorders Flashcards Preview

Neurology > Autonomic Disorders > Flashcards

Flashcards in Autonomic Disorders Deck (35)
1

True or false: orthostatic hypotension is a sign of *advanced* autonomic failure

True

2

True or false: impairments throughout the NS can produce autonomic s/sx

True

3

What are the three major cardiovagal heart rate tests?

-HR response to deep breathing
-HR response to valsalva
-HR response to standing

4

What are the two major adrenergic vasoconstriction (SNS) tests?

-BP valsalva maneuver response
-BP response to standing or tilt

5

What is the diagnostic criteria for orthostatic hypotension?

Drop of 20 / 10 or more upon standing from a supine position immediately, at 1 min, and 3 minutes after standing. Pulse should also increases by more than 20 bpm

6

Should a patient ever be checked in the sitting position for orthostasis?

No

7

How much should pulse go up in checking orthostatics with low blood volume? What if it does not?

At least 20

If not, then autonomic dysfunction

8

What are the treatments for orthostatic hypotension?

-HOB elevation
-Leg crossing, squatting
-Avoid prolonged standing
-Arise slowly

9

What is the dietary change that should be added with orthostatic hypotension?

Increased salt intake

10

What is the role of compression stocking and abdominal binders in treating orthostatic hypotension?

Used but not very effective

11

What are the first line agents for treatment of orthostatic hypotension? (4)

-Fludrocortisone
-Midodrine
-EPO
-Vasopressin analogues

12

What is the MOA of midodrine?

alpha-1 agonist

13

What is the MOA of clonidine?

Alpha-2 agonist

14

What is multi system atrophy (shy-Drager syndrome)?

Autonomic failure of orthostatic hypotension, impotence, and bladder/bowel dysfunction. Often presents as PD that is not responsive to L-DOPA treatment

15

What are the motor s/sx of MSA?

Parkinson Disease and cerebellar dysfunctions

16

How common is orthostatic hypotension with Parkinson's?

Uncommon

17

What is the major bowel problem with PD?

Constipation

18

What are the s/sx of pure ANS failure (aka idiopathic orthostatic hypotension)?

-Idiopathic orthostatic hypotension

19

What are the ANS s/sx of GB syndrome?

-Tachyarrhythmia
-Bradycardia or asystole
-Large swings in BP
-Urinary retention
-Pupil dysfunction
-GI dysmotility with ileus

20

What are the heart ANS dysfunction with GB syndrome?

-Tachyarrhythmia
-Bradycardia or asystole
-Large swings in BP

21

What are the CSF findings of GB syndrome?

Large amount of protein, low cell counts

22

What are the GU and GI ANS s/sx of GB syndrome?

-Urinary retention
-GI dysmotility with ileus

23

What are the eye ANS findings associated with GB syndrome?

Pupil dysfunction

24

What is acute autonomic neuropathy?

Similar to GB syndrome, but with pandysautonomia with progression over weeks

25

What is the most common paraneoplastic syndrome?

SCLC

26

What is the classic lung cancer that causes Lambert-Eaton syndrome?

antibodies are formed against presynaptic voltage-gated calcium channels, and likely other nerve terminal proteins, in the neuromuscular junction

27

What are the s/sx of subacute sensory neuropathy?

-Dysesthesias
-Autonomic neuropathy

28

What is the most common paraneoplastic cause of enteric neuronopathy?

SCLC

29

What are the ANS s/sx of DM neuropathy? (4)

-Orthostatic hypotension
-Bladder dysfunction
-Poor gut motility
-sudomotor dysfunction

30

What are the three major infectious causes of autonomic neuropathy?

-HIV
-Leprosy
-Syphilis

31

What is the most common cause of neuropathy in the US? Worldwide?

DM in the US
Leprosy in the world

32

What is postural orthostatic tachycardia syndrome (POTS)?

Postural related tachycardia w/o BP changes

30 BPM difference

33

What are the s/sx of POTS? (4)

-Lightheaded
-Fatigue
-Weakness
-MS change

34

Is there autonomic dysfunction with hyperhidrosis?

No

35

What change in orthostatic hypotension indicates an autonomic dysfunction, as compared to just volume depletion?

No change in HR is indicative of autonomic dysfunction