Clinical Autonomic Research

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

The physical examination as a window into autonomic disorders

Review

Abstract

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.

Keywords

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

Abbreviations

ANS

Autonomic nervous system

BP

Blood pressure

ENS

Enteric nervous system

MSA

Multiple system atrophy

OH

Orthostatic hypotension

OI

Orthostatic intolerance

PAF

Pure autonomic failure

PD

Parkinson’s disease

PNS

Parasympathetic nervous system

POTS

Postural tachycardia syndrome

SAS

Sympathetic adrenergic system

SCS

Sympathetic cholinergic system

SNS

Sympathetic noradrenergic system

Notes

Compliance with ethical standards

Funding

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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