Clinical Autonomic Research

, Volume 28, Issue 1, pp 23–33 | Cite as

The physical examination as a window into autonomic disorders

  • William P. CheshireJr.
  • David S. Goldstein


Signs of autonomic dysfunction, although at times seemingly mysterious, can contribute to diagnostic clarification and clinical investigation. Even when sophisticated autonomic testing equipment is not readily available, the experienced clinician, through educated observation and inductive reasoning—in conjunction with an intelligently obtained autonomic medical history—can discern much by a careful physical examination. Elements of the autonomic examination include variations in the pulse, postural measurements of blood pressure and heart rate, pupillary light reactions, skin coloration and temperature, patterns of sweating, and other organ-specific physical findings relevant to the individual patient’s presentation. Especially important is the often neglected practice of measuring the blood pressure standing up, for orthostatic hypotension cannot be diagnosed by symptoms alone and is a common source of potential morbidity. The examination should be carried out in the context of understanding the syndromic nature of abnormalities of components of the autonomic nervous system.


Physical examination Blood pressure determination Vital signs Autonomic nervous system diseases Autonomic pathways 



Autonomic nervous system


Blood pressure


Enteric nervous system


Multiple system atrophy


Orthostatic hypotension


Orthostatic intolerance


Pure autonomic failure


Parkinson’s disease


Parasympathetic nervous system


Postural tachycardia syndrome


Sympathetic adrenergic system


Sympathetic cholinergic system


Sympathetic noradrenergic system


Compliance with ethical standards


The research reported here was supported by the Division of Intramural Research, NINDS, NIH.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of NeurologyMayo ClinicJacksonvilleUSA
  2. 2.Clinical Neurocardiology Section, Clinical Neurosciences Program, Division of Intramural ResearchNational Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaUSA

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