Neurology · MU Sofia

35. Autonomic syndromes, autonomic innervation of pelvic and genital organs, syndromes of impairment

Covers autonomic syndromes caused by sympathetic or parasympathetic dysfunction, listing general features of autonomic failure across cardiovascular, sudomotor, pupillary, gastrointestinal and genitourinary systems. It then describes Horner syndrome with its triad and causes, dysautonomia and paroxysmal disturbances. The note also sets out sympathetic, parasympathetic and pudendal innervation of the pelvic and genital organs, with a function summary table, neurogenic bladder types, sexual dysfunction, cauda equina and conus syndromes, and a table of lesion levels.

Inside: 1 section · 2 tables · 15 flashcards · 3 min

Topic 35 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 335 words (3 min of reading), with 15 flashcards.

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  1. Autonomic syndromes. Autonomic innervation of pelvic and genitales organs. Syndromes of impairment

Autonomic syndromes. Autonomic innervation of pelvic and genitales organs. Syndromes of impairment

1. Autonomic Syndromes

Autonomic syndromes occur due to dysfunction of the sympathetic and/or parasympathetic nervous system, affecting visceral organs, skin, and vascular tone.

A. General Features of Autonomic Failure

1.Cardiovascular: Orthostatic hypotension. Syncope (fainting). Fixed heart rate (loss of variability)

2.Sudomotor (sweating): Hyperhidrosis or anhidrosis. Heat intolerance

3.Pupillary: Miosis or mydriasis. Poor light reflex

4.Gastrointestinal: Constipation. Diarrhea (sometimes alternating)

5.Genitourinary: Urinary retention or incontinence. Sexual dysfunction

B. Key Autonomic Syndromes

1. Horner Syndrome (Sympathetic lesion)

  • Triad: Ptosis. Miosis. Anhidrosis
  • Causes: Brainstem lesion. Cervical spinal cord lesion. Carotid artery dissection. Lung apex tumor (Pancoast tumor)

2. Autonomic (Dysautonomia) Failure

  • Features: Severe orthostatic hypotension. Erectile dysfunctio nBladder dysfunction. Impaired sweating
  • Seen in: Parkinson disease. Multiple system atrophy. Diabetes mellitus

3. Paroxysmal Autonomic Disturbances: Sudden episodes of sweating. BP fluctuations. Tachycardia/bradycardia episodes

2. Autonomic Innervation of Pelvic and Genital Organs

Pelvic organs are controlled by a balance of:

  • Sympathetic (T11–L2)
  • Parasympathetic (S2–S4)
  • Somatic (pudendal nerve S2–S4)

A. Sympathetic System (T11–L2)

Functions: “Storage & Ejaculation”

  • Bladder relaxation (detrusor relaxation)
  • Internal urethral sphincter contraction
  • Vas deferens contraction → ejaculation
  • Inhibits intestinal motility

Key role: Ejaculation (emission phase)

B. Parasympathetic System (S2–S4)

Functions: “Rest & Emptying”

  • Detrusor contraction → urination
  • Relaxation of internal sphincter
  • Vasodilation in erectile tissue → erection
  • Increased rectal motility

Key role: Erection

C. Somatic Innervation (Pudendal nerve S2–S4)

  • External urethral sphincter control
  • External anal sphincter
  • Voluntary control of micturition

3. Functional Control Summary

4. Syndromes of Autonomic Pelvic Dysfunction

A. Neurogenic Bladder

1. Spastic (Reflex) Bladder

Cause: Upper motor neuron lesion (above S2–S4)

Features: Urgency. Frequent urinationI ncontinence. Reflex emptying

2. Flaccid (Atonic) Bladder

Cause: Lower motor neuron lesion (S2–S4 or peripheral nerves)

Features: Urinary retention. Overflow incontinence Large bladder capacity

B. Sexual Dysfunction Syndromes

1. Erectile Dysfunction: Parasympathetic impairment. Common in diabetes and spinal cord injury

2. Ejaculatory Disorders

  • Sympathetic lesion → failure of ejaculation
  • Retrograde ejaculation (urine contains sperm)

C. Cauda Equina / Conus Medullaris Syndrome

Key autonomic signs: Urinary retention or incontinence. Loss of anal tone. Sexual dysfunctionS addle anesthesia

5. Key Clinical Lesions

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