EpistemisDysautonomia
Specialty: Neurology.
Why it occurs
- Advanced diabetic autonomic neuropathy
- Multiple system atrophy (Shy-Drager syndrome, parkinsonism with severe autonomic failure)
- Postural orthostatic tachycardia syndrome (POTS)
- Acute or subacute autoimmune autonomic neuropathy (associated with Guillain-Barré or autonomic ganglionopathy)
- Parkinson's disease with intrinsic or dopaminergic drug-induced autonomic dysfunction
Initial workup
Continuous monitoring of blood pressure and heart rate in standing and recumbent positions (Tilt Test); cardiovascular tests of autonomic function (heart rate variability with deep breathing and Valsalva maneuver); quantitative sweat test; analysis with plasma catecholamine levels in recumbent and standing positions; Urological ultrasound to assess post-void residue.
red flags
Dysautonomic crisis characterized by extreme fluctuations in blood pressure (severe supine hypertension alternating with severe orthostatic hypotension leading to repeated syncope with trauma), diffuse anhidrosis with risk of heat stroke, or neurogenic bladder with massive urinary retention and secondary hydronephrosis.
Standard management
- Midodrine — 2.5-10 mg three times a day, peripheral alpha-1 adrenergic agonist to treat orthostatic hypotension, avoiding nocturnal doses
- Fludrocortisone — 0.1-0.3 mg/day, mineralocorticoid to expand plasma volume
- Pyridostigmine — 30-60 mg three times a day
- First-line non-pharmacological measures (increased water and salt intake, use of abdominal and lower limb compression stockings).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 4