Quick Review: Neurological Disorders (Quick Review Notes)
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Autonomic disorders may result from disorders that damage autonomic nerves or parts of the brain that help control body processes, or they may occur on their own, without a clear cause. Diabetes the most common cause. Peripheral nerve disorders. Parkinson disease. Autonomic neuropathies. Multiple system atrophy.
Pure autonomic failure. Spinal cord disorders. Disorders of the neuromuscular junction where nerves connect with muscles , such as botulism and Lambert-Eaton syndrome. In men, difficulty initiating and maintaining an erection erectile dysfunction can be an early symptom of an autonomic disorder. Autonomic disorders commonly cause dizziness or light-headedness due to an excessive decrease in blood pressure when a person stands orthostatic hypotension. People may sweat less or not at all and thus become intolerant of heat.
The eyes and mouth may be dry. After eating, a person with an autonomic disorder may feel prematurely full or even vomit because the stomach empties very slowly called gastroparesis. Some people pass urine involuntarily urinary incontinence , often because the bladder is overactive. Other people have difficulty emptying the bladder urine retention because the bladder is underactive. Constipation may occur, or control of bowel movements may be lost.
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During the physical examination, doctors can check for signs of autonomic disorders, such as orthostatic hypotension. For example, they measure blood pressure and heart rate while a person is lying down or sitting and after the person stands to check how blood pressure changes when position is changed. When a person stands up, gravity makes it harder for blood from the legs to get back to the heart. Thus, blood pressure decreases. To compensate, the heart pumps harder, and the heart rate increases. However, the changes in heart rate and blood pressure are slight and brief.
If the changes are larger or last longer, the person may have orthostatic hypotension. Blood pressure is also measured continuously while the person does a Valsalva maneuver forcefully trying to exhale without letting air escape through the nose or mouth—similar to straining during a bowel movement. Electrocardiography is done to determine whether the heart rate changes as it normally does during deep breathing and the Valsalva maneuver. A tilt table test may be done to check how blood pressure and heart rate change when position is changed.
In this test, blood pressure is measured before and after the person, who is lying flat on a pivoting table, is tilted into an upright position. The tilt table test and the Valsalva maneuver, done together, can help doctors determine whether a decrease in blood pressure is due to an autonomic nervous system disorder. Sweat testing is also done. For one sweat test, the sweat glands are stimulated by electrodes that are filled with acetylcholine and placed on the legs and forearm. Then, the volume of sweat is measured to determine whether sweat production is normal.
A slight burning sensation may be felt during the test. In the thermoregulatory sweat test, a dye is applied to the skin, and a person is placed in a closed, heated compartment to stimulate sweating. Sweat causes the dye to change color.
SparkNotes: Neurons, Hormones, and the Brain: The Nervous System
Doctors can then evaluate the pattern of sweat loss, which may help them determine the cause of the autonomic nervous system disorder. Disorders that may be contributing to the autonomic disorder are treated.
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If no other disorders are present or if such disorders cannot be treated, the focus is on relieving symptoms. Orthostatic hypotension: People are advised to elevate the head of the bed by about 4 inches 10 centimeters and to stand up slowly. Wearing a compression or support garment, such as an abdominal binder or compression stockings, may help. Consuming more salt and water helps maintain the volume of blood in the bloodstream and thus blood pressure. Sometimes drugs are used. Fludrocortisone helps maintain blood volume and thus blood pressure.
Midodrine helps maintain blood pressure by causing arteries to narrow constrict. These drugs are taken by mouth. Decreased or absent sweating: If sweating is reduced or absent, avoiding warm environments is useful. Urinary retention: If urinary retention occurs because the bladder cannot contract normally, people can be taught to insert a catheter a thin rubber tube through the urethra and into the bladder themselves. The catheter allows the retained urine in the bladder to drain out, thus providing relief.
People insert the catheter several times a day and remove it after the bladder is empty. Bethanechol can be used to increase bladder tone and thus help the bladder empty. Constipation: A high-fiber diet and stool softeners are recommended.
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If constipation persists, enemas may be necessary. Erectile dysfunction: Usually, treatment consists of drugs such as sildenafil , tadalafil , or vardenafil taken by mouth. Stool softeners such as docusate, lactulose , or polyethylene glycol.
Fiber supplements add bulk to the stool and thus stimulate the natural contractions of the intestine. Fiber supplements and stool softeners help move food through the intestine more quickly. These drugs stimulate contractions in the digestive tract and thus help move food through it more quickly. Erectile dysfunction.
Orthostatic hypotension an excessive decrease in blood pressure when a person stands. These drugs cause small arteries arterioles to narrow constrict and thus helps maintain blood pressure. Urinary incontinence. Urine retention. Merck and Co. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world.
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