Evaluation of Autonomic Failure

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Abstract
Autonomic dysfunction can manifiest in a myriad of symptoms. Through the years a number of different tests have been advocated to document the impact that many diseases have on the autonomic nervous system or to evaluate the extent or presence of autonomic dysfunction. Information obtained through autonomic testing is valuable in the diagnosis of many disorders including orthostatic hypotension due to primary autonomic failure or multiple system atrophy (Shy-Drager syndrome), diabetes mellitus, amyloidosis, porphyria, and neurocardiogenic syncope, among others. Autonomic testing can also be helpful to assess the adequacy and impact of therapeutic measurements of many of these diseases. This chapter presents information on the methods available to evaluate autonomic dysfunction. The tests have been subdivided according to the end organ response that they primarily evaluate and they include: 1) Integrated evaluation of blood pressure and heart rate. 2) Predominant evaluation of blood pressure responses. 3) Predominant evaluation of heart rate responses. 4) Evaluation of sweating and skin autonomic responses. 5) Test of pupillary innervation. 6) Determination of sympathetic function. A review of the methods, including the description of each method, the theoretical aspect of each test, how the test is performed as well as the interpretation of the results with advantages and disadvantages of each test, is presented.