Autonomic nerve fibers are small, lightly myelinated and unmyelinated and are injured to a varying degree in most symmetrical generalized, peripheral neuropathies.
While this injury is often mild or subclinical, there are a group of peripheral neuropathies in which the small or unmyelinated fibres are selectively or prominently targeted. These include the autonomic neuropathies associated with diabetes and amyloid; immune-mediated autonomic neuropathies including those associated with a paraneoplastic syndrome; inherited autonomic neuropathies; autonomic neuropathies associated with infections diseases and toxic autonomic neuropathies.
The presenting features include impairment of cardiovascular, gastrointestinal, urogenital, thermoregulatory, sudomotor and pupillomotor function in different combinations and severity. In some peripheral neuropathies, the autonomic features are the most prominent manifestation of the neuropathy, while, in others, autonomic manifestations may be less prominent compared to the sensory or motor manifestations.
This seminar will adopt a case based approach to illustrate the functional anatomy and physiology of the autonomic nervous system.
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