Autonomic Peripheral Neuropathy
Section snippets
Diabetic autonomic neuropathy
Diabetes mellitus is the most common cause of autonomic neuropathy in the developed world [2], [3]. This topic has been covered in detail in several recent reviews [4], [5]. Diabetic cardiovascular autonomic neuropathy often manifests initially as an increased resting heart rate caused by a cardiac vagal neuropathy. As the autonomic neuropathy progresses, cardiac sympathetic fibers are involved and the resting tachycardia is replaced with a slowed, and ultimately fixed, heart rate [6], [7], [8]
Amyloid neuropathy
Amyloidosis is caused by the deposition of insoluble fibrillar proteins in a beta-pleated sheet configuration within the extracellular space of various tissues and organs. Various amyloidogenic proteins have been associated with amyloidosis. The current classification of the systemic amyloidoses is based on the biochemistry of the precursor protein [52], [53]. Although the fibril precursor proteins differ, there are strong similarities between the clinical presentations and pathology of the
Guillain-Barré syndrome
Guillain-Barré syndrome (acute inflammatory demyelinating polyradiculoneuropathy) is a monophasic illness of immune etiology that presents as an acutely evolving sensorimotor polyneuropathy of varying severity. Autonomic manifestations such as sinus tachycardia, sinus pauses and other tachy- and bradyarrhythmias, blood pressure lability, bowel and bladder dysfunction, pupillomotor disturbances, sudomotor dysfunction, and vasomotor abnormalities frequently accompany Guillain-Barré syndrome [81],
Immune-mediated and paraneoplastic autonomic neuropathies (specific autoantibody-associated autonomic neuropathies)
Autonomic dysfunction has been associated with the presence of specific autoantibodies (Box 2). The subacute appearance of autonomic symptoms, including orthostatic hypotension, pupillomotor dysfunction, sudomotor dysfunction, constipation, urinary retention, impotence, and xerophthalmia, has been associated with the presence of anti-Hu antibodies (also known as Type 1 antineuronal nuclear antibody, ANNA-1) in patients with malignancies, especially small-cell lung cancer. Other associated
Hereditary autonomic neuropathies
The hereditary autonomic neuropathies are a heterogeneous group of disorders, some of which have significant involvement of autonomic fibers (see Box 1) [124], [125], [126], [127]. Autonomic features are most prominent in the hereditary sensory and autonomic neuropathies (HSAN) and Fabry's disease [124], [125], [126], [127]. Other hereditary autonomic neuropathies include Allgrove syndrome [128], Tangier disease [129], [130], [131], a sensory and autonomic neuropathy with arthropathy that is
Autonomic neuropathy caused by infectious diseases
The peripheral neuropathies associated with several infectious diseases have prominent accompanying autonomic manifestations.
Toxic neuropathies
Several industrial and environmental toxins and medications can cause autonomic neuropathy (see Box 1). Autonomic neuropathy has been reported in individuals exposed to organic solvents [189], [190], arsenic [191], mercury [192], other heavy metals [193], industrial-use acrylamide [194], thallium [192], [195], and the rat poison, Vacor (N-3-pyridylmethyl-N'-para-nitrophenyl urea) [196].
Autonomic neuropathy also may follow treatment with cytotoxic agents used in cancer chemotherapy. Clinically
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Cited by (40)
Effects of acute neurologic disease on the heart
2021, Handbook of Clinical NeurologyCitation Excerpt :Cardiovascular dysfunction may be seen in a variety of acute neuropathies with autonomic involvement including acute inflammatory demyelinating polyradiculoneuropathy (AIDP), immune-mediated autonomic neuropathies, or neuronopathies associated with underlying malignancy (paraneoplastic syndromes) or other systemic autoimmune conditions (i.e., Celiac disease, systemic lupus erythematosus, or Sjogren's syndrome) as well as acute autonomic and sensory neuropathy and acute autonomic, sensory and motor neuropathy. ( Freeman, 2007; Koike et al., 2013). Autonomic dysfunction has been described in up to two-thirds of patients with acute demyelinating polyradiculoneuropathy (Burakgazi and AlMahameed, 2016; Anandan et al., 2017; Zaeem et al., 2019).
Orthostatic Hypotension: JACC State-of-the-Art Review
2018, Journal of the American College of CardiologyCitation Excerpt :In some peripheral neuropathies, the small or unmyelinated autonomic fibers are selectively targeted, causing prominent autonomic features. These include: the autonomic neuropathies associated with diabetes and amyloid; immune-mediated autonomic neuropathies, including those associated with paraneoplastic syndromes; inherited autonomic neuropathies; and autonomic neuropathies associated with infectious diseases and toxic autonomic neuropathies (65,66). Diabetic autonomic neuropathy, the most prevalent autonomic neuropathy in the developed world, has manifestations that affect the cardiovascular, urogenital, gastrointestinal, pupillomotor, thermoregulatory, and sudomotor systems (67).
Congenital insensitivity to pain with anhidrosis: A report of two siblings with a novel mutation in (TrkA) NTRK1 gene in a Saudi family
2016, Journal of the Neurological SciencesThe older adult with diabetes: Peripheral neuropathy and walking for health
2014, Nursing Clinics of North AmericaCitation Excerpt :Weakness of these muscles leads to toe and foot deformities. Autonomic neuropathy (AN), when severe, usually results in a global anhidrosis (diminished or absent sweating) and this initial loss of normal thermoregulatory sweating proceeds in a stocking pattern in the lower limbs.17 As a result, patients experience dryness of the feet that contributes to the formation of cracks and fissures.
Therapy for diabetic neuropathy: An overview
2014, Handbook of Clinical NeurologyCitation Excerpt :Arginine-vasopressin peaks during the night. Patients suffering from autonomic failure have increased urinary excretion during the night because of increased supine blood pressure and a loss of vasopressin neurons in the suprachiasmatic nucleus of the hypothalamus (Freeman, 2007). The synthetic analog is called desmopressin acetate and activates the V2 receptors of the collecting ducts of the renal tubules.