Autonomic Disorders Flashcards
What is the hx of Non-neurogenic orthostatic hypotension?
- Dimming of vision
- Dizziness or lightheadedness
- Sweating
- Pallor
- Paroxysmal weakness
- Loss of consciousness
What do pt w/ non-neurogenic orthostatic HOTN frequently have?
- Hx of HTN or heart dz
- Take meds that cause orthostatic HOTN
What is Orthostatic HOTN?
Drop in systolic BP of >20mmHg d/or a drop in diastolic BP >10mmHg w/in 3min of standing from a supine position. Compensatory inc in pulse rate of >15 BPM
What is the cause of Orthostatic HOTN?
Reduction in perfusion to the brain upon standing resulting in sx
What is the tx of Orthostatic HOTN?
- Meds adjustment
- Correct hypovolemia
- Exercise
- Correct anemia
Who gets Orthostatic HOTN assoc w/ brain disorders?
Older adults
What is the duration of orthostatic HOTN assoc w/ brain disorders?
Subacute or chronic
What is the hx of orthostatic HOTN assoc w/ brain disorder?
- Neuro sx
- Parkinsonian-like sx freq
- Cerebellar dysfxn
- Other autonomic sx
- CNS disturbances
What are Autonomic sx?
- Diarrhea
- Constipation
- Urinary retention
- ED
- Sweating disturbances
What are the CNS distrubances?
- Language
- Memory
- Speech
- Swallowing
What are the PE findings of orthostatic HOTN w/ brain disorders?
- Orthostatic HOTN
- No compensatory in in HR
- Neuro findings suggestive of CNS distrubance
What are the neuro findings of CNS distrubances?
- ABN of muscle tone
- Ataxia
- Tremor
- ABN pupillary light reflexes
- Gait disorder
What are the tech findings of orthostatic HOTN w/ brain disorder?
ABN autonomic testing
ABN findings on brain MRI
What is the tx of orthostatic HOTN w/ brain disorders?
- Check meds
- Hydration
- Exercise as tolerated
- Libral salt
- Alpha sympathetic agonist
- Pressure hose to promote venous return to the hear
What are the hx/sx of orthostatic HOTN assoc w/ peripheral nerve dysfxn?
- Stocking glove sensory disturbances
- Peripheral weakness
- Autonomic sx
What are the tech features of orthostatic HOTN assoc w/ peripheral neuropathy?
ABN autonomic testing
What causes orthostatic HOTN assoc w/ peripheral neuropathy?
Post-ganglionic autonomic fibers PNS are subject to same dz processes that motor & sensory fibers subject to
What are the PE findings of Horner’s synd?
- Ptosis
- Miosis
- Anyhdrosis
What are the sx of ANS disturbance?
- Anhydrosis
- Orthostatic hypotension *MC!
- ABN pupillary reflexes
- Dec lacrimation/salivation
- ED
- Bowel/bladder dysfunction
What is the craniosacral ANS?
PNS
What is the thoracolumbar ANS?
SNS
How does the SNS innervate the pupil?
SC→ sympathetic chain ganglion→Post ganglionic fibers→ Dilator pupillae→ DILATE
How does the PNS innervate the pupil?
CN III→ ciliac ganglion→ short ciliary n.→ciliary muslce of the pupil→ CONSTRICT
What muscle raises the eyelid?
Muller’s muscle innervated by the SNS
