Elsevier

Neurologic Clinics

Volume 25, Issue 1, February 2007, Pages 277-301
Neurologic Clinics

Autonomic Peripheral Neuropathy

https://doi.org/10.1016/j.ncl.2007.01.001Get rights and content

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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