Neurology · MU Sofia

83. Diseases of the autonomic nervous system

Covers the anatomy of the sympathetic and parasympathetic branches and the neurotransmitters each uses, then sorts autonomic disorders into primary failure and secondary neuropathies. Clinical features are set out by organ system, followed by named syndromes such as Horner syndrome, autonomic dysreflexia and pure autonomic failure. The note also outlines bedside and laboratory tests, differential diagnosis, and treatment options for orthostatic hypotension, bladder and gastrointestinal symptoms.

Inside: 9 sections · 16 flashcards · 2 min

Topic 83 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 9 sections, about 292 words (2 min of reading), with 16 flashcards.

In this note

  1. Diseases of the autonomic nervous system
  2. Anatomy of the ANS
  3. Classification of Autonomic Disorders
  4. Clinical Manifestations
  5. Important Autonomic Syndromes
  6. Clinical Examination
  7. Diagnosis
  8. Differential Diagnosis
  9. Treatment

Diseases of the autonomic nervous system

Definition: Diseases of the autonomic nervous system (ANS) are disorders affecting the sympathetic and/or parasympathetic nervous systems, resulting in impaired regulation of involuntary functions such as:

  • Blood pressure. Heart rate. Sweating. Gastrointestinal motility. Urination. Sexual function

Anatomy of the ANS

Sympathetic System (Thoracolumbar)

  • Origin: T1–L2 spinal cord
  • Neurotransmitter:
  • Preganglionic: Acetylcholine
  • Postganglionic: Noradrenaline

Parasympathetic System (Craniosacral)

  • Cranial nerves III, VII, IX, X
  • S2–S4 spinal segments
  • Neurotransmitter: Acetylcholine

Classification of Autonomic Disorders

1. Primary Autonomic Failure

  • Neurodegenerative diseases affecting autonomic pathways: Multiple System Atrophy (MSA). Pure Autonomic Failure. Parkinson Disease with autonomic dysfunction

2. Secondary Autonomic Neuropathies

  • Due to systemic diseases: Diabetes mellitus (most common). Amyloidosis. Chronic alcoholism. Uremia. Autoimmune diseases

Clinical Manifestations

A. Cardiovascular Dysfunction

  • Orthostatic Hypotension (Most Important): Fall in BP on standing. Dizziness. Syncope. Blurred vision

B. Sudomotor Dysfunction: Anhidrosis (reduced sweating). Hyperhidrosis (excess sweating). Heat intolerance

C. Gastrointestinal Dysfunction: Dysphagia. Gastroparesis. Constipation. Diarrhea

D. Genitourinary Dysfunction: Urinary retention. Urinary incontinence. Erectile dysfunction

E. Pupillary Dysfunction: Abnormal light response. Impaired accommodation

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