Diagnosis Of Autonomic Dysfunction Research Articles

FV 7. Cross-sectional area of the vagus nerve correlates with parasympathetic dysfunction in Parkinson's Disease

Introduction . In this study we evaluated the autonomic neural function in Parkinson's disease (PD) by combining the use of clinical scoring, functional evaluation with head-up tilt test (HUTT) and morphological studies of the vagus nerve (VN) with nerve ultrasound (NU). This allowed us to correlate morphological changes of the VN with markers of parasympathetic dysfunction from HUTT. Patients/Methods. In our study we used NU to compare the mean values of the cross-sectional area (CSA) of the VNs of 80 PD patients with those of controls (n=40) and patients with chronic inflammatory demyelinating polyneuropathy (CIDP) (n=76). In 69 cases HUTT data was analyzed concerning the presence of orthostatic hypotension (OH), postural orthostatic tachycardia syndrome (POTS) and chronotropic incompetence (CI). Functional haemodynamic parameters in HUTT were used to evaluate parasympathetic functions and correlate them with VN CSA (n=65). Results . In PD, the CSA of right / left VN was significantly smaller compared to the right/left VN of the control and CIDP patients (Table 1). Based on HUTT, 60.5 % of the patients were diagnosed with autonomic dysfunction (OH n=11, CI n=31, POTS n=1). Patients with OH showed significantly higher UPDRS-III values than those with CI (p=0.025). The CSA of the VN correlated inversely with heart rate and positively with parameters representing parasympathetic modulation through vagal activity (Fig. 1). Conclusion . By using NU significant morphological differences of the CSA of the VN were detected in CIDP, PD and a healthy control group. Furthermore, we demonstrated for the first time that anatomical characteristics of the VN correlate with parameters of parasympathetic function from the spectral analysis of cardiovascular parameters in HUTT for PD. This finding enables a new interpretation of the anatomical characteristics of the VN for PD patients and diagnosis of autonomic dysfunction. Fig. 1. Schematic presentation of the inverse correlation of the cross-sectional area of the right vagus nerve with the heart rate. Positive correlation with markers of parasympathetic activity HFnu-RRI. (Spearman Correlation). Abbreviations: HR=heart rate, HFnuRRI = high frequency power of the RR-Interval, bpm= beats per minute, CSA= cross-sectional area Table 1. Demographical and epidemiological characteristics as well as the cross-sectional area (CSA) of the vagus nerve. All values are provided as mean ± standard deviation. Abbreviations: INCAT/ODSS = inflammatory neuropathy cause and treatment/overall disability sum score, MDS-UPDRS III= MDS-Unified Parkinson's Disease Rating Scale, SCOPA-AUT= Scales for Outcomes in Parkinson's Disease- Autonomic Dysfunction, PDQ39 = Parkinson's Disease Questionnaire, CSA = cross sectional area.

Comparison of Autonomic Functions in Perimenopausal Women with Postmenopausal Women

Comparison of Autonomic Functions in Perimenopausal Women with Postmenopausal Women

PTU-132 Autonomic Function Scores and Sleep Disturbance Scores in FGID Patients with and Without Upper Limb Temperature Dissociation

Introduction Background Central autonomic dysfunction may result in a unilateral dissociation of temperature sensation, and is increasingly being investigated in FGIDs. The autonomic function score (AFS) and sleep disturbance score (SDS) are accepted measures in aiding the diagnosis of autonomic dysfunction. Aims To assess and compare the AFS and SDS of consecutive FGID patients attending a specialist clinic, with and without upper limb temperature dissociation. Methods Clinic attenders with a FGID diagnosis were sequentially invited to undertake the temperature sensation test. This comprised holding a bag of ice in both hands for 30 seconds and stating if they perceived the temperature to be either unilaterally colder or bilaterally equally cold. Unilaterally colder was considered to be evidence of upper limb temperature sensory dissociation. Patients had their total AFS calculated as follows: headaches, dizziness, sweating and sleep disturbance were severity scored using a Likert scale of 0–3, the sum of which is the AFS. The mean total AFS and mean sleep disturbance score were compared between patients with and without temperature dissociation. Results 173 patients completed the AFS and 7 were excluded from the analysis for incomplete data leaving 166. 115 patients (69%) had upper limb temperature dissociation (group 1) compared to 51 (31%) with normal temperature sensation bilaterally (group 2). The mean total AFS in group 1 was 6.35 [SD 3.17] compared with 5.01 [SD 2.87] in group 2 [P = 0.009]. Mean sleep disturbance scores were not significantly different between the groups. Conclusion FGID patients with upper limb temperature dissociation appear to have a significantly higher autonomic function score than those without temperature dissociation. This seems to suggest that the cause of the temperature dissociation may well be due to autonomic dysfunction acting at a central nervous system level. These results are an interesting observation from our clinic but are likely to be limited by inherent methodological biases in the data collection. Further investigation of autonomic function scores and temperature dissociation are required in formal and appropriately powered clinical research studies to validate these findings. Disclosure of Interest None Declared

Cerebral blood flow during HUTT in young patients with orthostatic intolerance.

To investigate patterns of change in cerebral perfusion during head-up tilt testing (HUTT) in children and young adults with autonomic dysfunction. We utilized near-infrared spectroscopy (NIRS) to estimate bilateral cerebral perfusion patterns during HUTT in 71 adolescents and young adults with a diagnosis of autonomic dysfunction. In addition, we used transthoracic impedance to measure cardiac stroke volume and thus infer autonomic tone, heart rate, and blood pressure during the test. Cerebral blood-flow wave-patterns were then visually analyzed and associated with clinical symptoms and measures of cardiovascular and autonomic function. Visual analysis of contour changes in head NIRS values during phases of HUTT revealed variable patterns of cerebral blood flow, some specifically associated with severe symptomatology (i.e., syncope). We also observed an inequality in blood flow of the cerebral hemispheres in many patients. Finally, we observed changes in cardiac stroke volume during HUTT, as previously reported, that related to changes in head NIRS. These results confirm a decrease in cerebral blood flow during HUTT as assessed by head NIRS in patients with autonomic dysfunction. Specifically, we have profiled the cerebral blood flow contours throughout the phases of HUTT, which add insight into the clinical spectrum of the disorder and may correlate with clinical severity.

Autonomic neuropathy in anaesthesia

Autonomic neuropathy is a common problem encountered by anaesthetists, both in operating theatres and in the critical care setting. There are a wide variety of causes, many of them associated with significant co-morbidity. It is clear that it is a problem which involves every system on a number of levels, and many of the issues are of particular significance to the anaesthetist. This review will cover briefly the aetiology and diagnosis of autonomic dysfunction, before discussing the clinical manifestations and consequences of the disorder. The major focus will be on cardiovascular autonomic neuropathy (CAN) and its implications for the peri-operative phase. In addition, it will briefly look at the involvement of the enteric nervous system, as well as deal with some of the new concepts emerging in the literature.

33-jähriger Patient mit rezidivierenden Synkopen und orthostatischer Hypotension

We describe the case of a 33 year old male patient with severe orthostatic hypotension, which was at times even in upright (sitting) position not tolerated, thus leading to complete immobilisation. The diagnostic measurements pointed to the group of primary autonomic degenerative disorders, the so-called "synucleinopathies". The clinical presentation und laboratory values confirmed the diagnosis of "pure autonomic failure". Finally, we describe the differential diagnosis of autonomic dysfunction.

Difficulties in the diagnosis of autonomic dysfunction in multiple sclerosis

Autonomic function was assessed in 24 patients with multiple sclerosis using a questionnaire, cardiovascular reflex tests and sympathetic skin responses. Most patients had some degree of dysautonomia.

Predictive value of 24-hour ambulatory blood pressure monitoring in the diagnosis of autonomic dysfunction

Predictive value of 24-hour ambulatory blood pressure monitoring in the diagnosis of autonomic dysfunction

PS-63-9 Usefulness of non-invasive valsalva test for the diagnosis of autonomic dysfunction in diabetic neuropathy

PS-63-9 Usefulness of non-invasive valsalva test for the diagnosis of autonomic dysfunction in diabetic neuropathy