Skip to main content

Advertisement

SpringerLink
Log in

The autonomic medical history

  • Review
  • Published:
Clinical Autonomic Research Aims and scope Submit manuscript

Abstract

The most important autonomic function test—the autonomic medical history—is the patient’s account, interpreted by a clinician skilled in asking the right questions, of symptoms during daily activities that relate to the autonomic nervous system. The chronology and pattern of these symptoms combine to create a portrait of autonomic function or dysfunction. We summarize the steps in obtaining a comprehensive autonomic medical history.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

AAG:

Autoimmune autonomic ganglionopathy

ANS:

Autonomic nervous system

COI:

Chronic orthostatic intolerance

EDS:

Ehlers–Danlos syndrome

ENS:

Enteric nervous system

EPI:

Epinephrine

HPI:

History of the present illness

HSAN:

Hereditary sensory and autonomic neuropathy

MSA:

Multiple system atrophy

NE:

Norepinephrine

OH:

Orthostatic hypotension

OI:

Orthostatic intolerance

PAF:

Pure autonomic failure

PNS:

Parasympathetic nervous system

POTS:

Postural tachycardia syndrome

ROS:

Review of systems

SAS:

Sympathetic adrenergic system

SCS:

Sympathetic cholinergic system

SNS:

Sympathetic noradrenergic system

References

  1. Birdsong WT, Fierro L, Williams FG, Spelta V, Naves LA, Knowles M, Marsh-Haffner J, Adelman JP, Almers W, Elde RP, McCleskey EW (2010) Sensing muscle ischemia: coincident detection of acid and ATP via interplay of two ion channels. Neuron 68:739–749

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Cannon WB (1919) Bodily changes in pain, hunger, fear and rage. Appleton, New York

    Google Scholar 

  3. Cheshire WP Jr (2017) Syncope. Continuum (Minneap Minn) 23:335–358

  4. Cheshire WP (2016) Stimulant medication and postural orthostatic tachycardia syndrome: a tale of two cases. Clin Auton Res 26:229–233

    Article  PubMed  Google Scholar 

  5. Cheshire WP, Fealey RD (2008) Drug-induced hyperhidrosis and hypohidrosis: incidence, prevention and management. Drug Saf 31:109–126

    Article  CAS  PubMed  Google Scholar 

  6. Cheshire WP Jr (2000) Hypotensive akathisia: autonomic failure associated with leg fidgeting while sitting. Neurology 55:1923–1926

    Article  PubMed  Google Scholar 

  7. Cryer PE (2006) Hypoglycemia in diabetes: pathophysiological mechanisms and diurnal variation. Prog Brain Res 153:361–365

    Article  CAS  PubMed  Google Scholar 

  8. Dean GE, Nelson PJ, Rudnick G (1986) Characterization of native and reconstituted hydrogen ion pumping adenosinetriphosphatase of chromaffin granules. Biochemistry 25:4918–4925

    Article  CAS  PubMed  Google Scholar 

  9. Eder AF (2012) Current efforts to reduce the risk of syncope among young blood donors. Curr Opin Hematol 19:480–485

    Article  PubMed  Google Scholar 

  10. Espinosa-Medina I, Saha O, Boismoreau F, Chettouh Z, Rossi F, Richardson WD, Brunet JF (2016) The sacral autonomic outflow is sympathetic. Science 354:893–897

    Article  CAS  PubMed  Google Scholar 

  11. Garland EM, Robertson D (2001) Chiari I malformation as a cause of orthostatic intolerance symptoms: a media myth? Am J Med 111:546–552

    Article  CAS  PubMed  Google Scholar 

  12. Goldstein DS (2017) Principles of autonomic medicine. https://neuroscience.nih.gov/publications/Principles%20of%20Autonomic%20Medicine%20v.%202.1.pdf. Accessed 1 Jan 2017

  13. Goldstein DS, Eldadah B, Holmes C, Pechnik S, Moak J, Sharabi Y (2005) Neurocirculatory abnormalities in chronic orthostatic intolerance. Circulation 111:839–845

    Article  PubMed  Google Scholar 

  14. Goldstein DS, Holmes C, Dendi R, Li ST, Brentzel S, Vernino S (2002) Pandysautonomia associated with impaired ganglionic neurotransmission and circulating antibody to the neuronal nicotinic receptor. Clin Auton Res 12:281–285

    Article  PubMed  Google Scholar 

  15. Goldstein DS, Holmes C, Sewell L, Park MY, Sharabi Y (2012) Sympathetic noradrenergic before striatal dopaminergic denervation: relevance to Braak staging of synucleinopathy. Clin Auton Res 22:57–61

    Article  PubMed  Google Scholar 

  16. Goldstein DS, Li ST, Kopin IJ (2001) Sympathetic neurocirculatory failure in Parkinson disease: evidence for an etiologic role of alpha-synuclein. Ann Intern Med 135:1010–1011

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Hakim A, O’Callaghan C, De Wandele I, Stiles L, Pocinki A, Rowe P (2017) Cardiovascular autonomic dysfunction in Ehlers–Danlos syndrome—hypermobile type. Am J Med Genet C Semin Med Genet 175:168

    Article  PubMed  Google Scholar 

  18. Hayat A, Whittam D (2014) Baroreceptor failure related to bilateral carotid artery disease: an uncommon cause of labile hypertension. Intern Med J 44:105–106

    Article  CAS  PubMed  Google Scholar 

  19. Isonaka R, Holmes C, Cook GA, Sullivan P, Sharabi Y, Goldstein DS (2017) Pure autonomic failure without synucleinopathy. Clin Auton Res 27:97

    Article  PubMed  Google Scholar 

  20. Jafari S, Etminan M, Aminzadeh F, Samii A (2013) Head injury and risk of Parkinson disease: a systematic review and meta-analysis. Mov Disord 28:1222–1229

    Article  PubMed  Google Scholar 

  21. Kanjwal K, Karabin B, Kanjwal Y, Grubb BP (2010) Autonomic dysfunction presenting as postural tachycardia syndrome following traumatic brain injury. Cardiol J 17:482–487

    PubMed  Google Scholar 

  22. Kanjwal K, Karabin B, Kanjwal Y, Grubb BP (2011) Postural orthostatic tachycardia syndrome following Lyme disease. Cardiol J 18:63–66

    PubMed  Google Scholar 

  23. Kaufmann H, Goldstein DS (2010) Pure autonomic failure: a restricted Lewy body synucleinopathy or early Parkinson disease? Neurology 74:536–537

    Article  PubMed  Google Scholar 

  24. Khurana RK (2012) Coat-hanger ache in orthostatic hypotension. Cephalalgia 32:731–737

    Article  PubMed  Google Scholar 

  25. Langley JN (1921) The autonomic nervous system. Heffer, Cambridge

    Google Scholar 

  26. Nogues M, Delorme R, Saadia D, Heidel K, Benarroch E (2001) Postural tachycardia syndrome in syringomyelia: response to fludrocortisone and beta-blockers. Clin Auton Res 11:265–267

    Article  CAS  PubMed  Google Scholar 

  27. Pederson CL, Brook JB (2017) Health-related quality of life and suicide risk in postural tachycardia syndrome. Clin Auton Res 27:75–81

    Article  PubMed  Google Scholar 

  28. Prilipko O, Dehdashti AR, Zaim S, Seeck M (2005) Orthostatic intolerance and syncope associated with Chiari type I malformation. J Neurol Neurosurg Psychiatry 76:1034–1036

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Rowe PC, Barron DF, Calkins H, Maumenee IH, Tong PY, Geraghty MT (1999) Orthostatic intolerance and chronic fatigue syndrome associated with Ehlers–Danlos syndrome. J Pediatr 135:494–499

    Article  CAS  PubMed  Google Scholar 

  30. Schachter S, Singer J (1962) Cognitive, social, and physiological determinants of emotional state. Psychol Rev 69:379–399

    Article  CAS  PubMed  Google Scholar 

  31. Shannon JR, Flattem NL, Jordan J, Jacob G, Black BK, Biaggioni I, Blakely RD, Robertson D (2000) Orthostatic intolerance and tachycardia associated with norepinephrine-transporter deficiency. N Engl J Med 342:541–549

    Article  CAS  PubMed  Google Scholar 

  32. Sharabi Y, Dendi R, Holmes C, Goldstein DS (2003) Baroreflex failure as a late sequela of neck irradiation. Hypertension 42:110–116

    Article  CAS  PubMed  Google Scholar 

  33. Singleton A, Gwinn-Hardy K, Sharabi Y, Li ST, Holmes C, Dendi R, Hardy J, Crawley A, Goldstein DS (2004) Association between cardiac denervation and parkinsonism caused by alpha-synuclein gene triplication. Brain 127:768–772

    Article  PubMed  Google Scholar 

  34. Sletten DM, Suarez GA, Low PA, Mandrekar J, Singer W (2012) COMPASS 31: a refined and abbreviated composite autonomic symptom score. Mayo Clin Proc 87:1196–1201

    Article  PubMed  PubMed Central  Google Scholar 

  35. Smits-Engelsman B, Klerks M, Kirby A (2011) Beighton score: a valid measure for generalized hypermobility in children. J Pediatr 158:119–123

    Article  PubMed  Google Scholar 

  36. Timmers HJ, Buskens FG, Wieling W, Karemaker JM, Lenders JW (2004) Long-term effects of unilateral carotid endarterectomy on arterial baroreflex function. Clin Auton Res 14:72–79

    Article  PubMed  Google Scholar 

  37. Wieling W, van Dijk N, Thijs RD, de Lange FJ, Krediet CT, Halliwill JR (2015) Physical countermeasures to increase orthostatic tolerance. J Intern Med 277:69–82

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinical Neurocardiology Section, Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 9000 Rockville Pike MSC-1620, Building 10 Room 5N220, Bethesda, MD, 20892-1620, USA

    David S. Goldstein

  2. Department of Neurology, Mayo Clinic, Jacksonville, FL, 32224, USA

    William P. Cheshire Jr

Authors
  1. David S. Goldstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William P. Cheshire Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David S. Goldstein.

Ethics declarations

Conflict of interest

The authors state that there is no conflict of interest.

Funding

The research reported here was supported by the Division of Intramural Research, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goldstein, D.S., Cheshire, W.P. The autonomic medical history. Clin Auton Res 27, 223–233 (2017). https://doi.org/10.1007/s10286-017-0425-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10286-017-0425-7

Keywords

Search

Navigation