Clinical Evaluation of Autonomic Disorders

This chapter presents clinical evaluation of autonomic disorders and assessment through bedside and laboratory testing. A preliminary evaluation can be easily done at the bedside, at least for the most disabling symptom of autonomic dysfunction. Significant decrement in BP without compensatory tachycardia is needless to say much worse prognostically than marked tachycardia without significant BP changes. Secretomotor and sudomotor functions may be assessed simply by observation of the mucosae and by appreciating presence of moisture on the skin by palpation or by dragging a metal object on the skin. Hyperhidrosis may be appreciated quite easily, as sweat droplets over the skin, visibly wet garments or as wet stains in shoes. Occasionally, when the nature of the spells is unclear despite many investigations, simultaneous EEG monitoring may identify an ictal bradycardia or asystole and on the other hand provide confirmation that convulsive manifestations not uncommonly seen in syncope are secondary to the hemodynamic changes.