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Autonomic Neuropathies

by Phillip Low, MD

Autonomic neuropathies are peripheral nerve disorders with disproportionate involvement of autonomic fibers.

The best known autonomic neuropathies are those accompanying peripheral neuropathy due to diabetes, amyloidosis, or autoimmune disorders.

Autoimmune autonomic neuropathy is an idiopathic disorder that often develops after a viral infection; onset may be subacute.

Autonomic insufficiency is usually a late manifestation in alcoholic neuropathy.

Other causes can include toxins, drugs, and paraneoplastic syndromes.

Symptoms and Signs

Common symptoms of autonomic neuropathies include orthostatic hypotension, neurogenic bladder, erectile dysfunction, gastroparesis, and intractable constipation. When somatic fibers are involved, sensory loss in a stocking-and-glove distribution and distal weakness may occur (see also Overview of Peripheral Nervous System Disorders).


  • Clinical evaluation

Diagnosis of autonomic neuropathy is based on demonstration of autonomic failure and of a specific cause of neuropathy (eg, diabetes, amyloidosis). Autoimmune autonomic neuropathy may be suspected after a viral infection. Ganglionic anti–acetylcholine receptor antibody A 3 is present in about half of patients with autoimmune autonomic neuropathy and is occasionally present in patients with other autonomic neuropathies.


  • Treatment of underlying disorders

Underlying disorders are treated.

Autoimmune autonomic neuropathy may respond to immunotherapy; plasma exchange or IV γ-globulin can be used for more severe cases.

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