The autonomic nervous system regulates involuntary body functions and is divided into the sympathetic and parasympathetic nervous systems. The sympathetic system activates the fight or flight response while the parasympathetic system promotes rest and digestion. Autonomic dysfunction occurs when these nerves are damaged, as from conditions like diabetes or Parkinson's disease, causing issues like low blood pressure, digestive problems, and urinary incontinence. Doctors evaluate the autonomic nervous system through tests of blood pressure changes, sweating, and pupil response and treat issues by addressing symptoms and underlying causes through lifestyle changes and medications.

1. Autonomic Nervous System ,Examination ,Lesion
Syndromes
Prepared by : Syed Hassnain Shah
Group # 1st
Semester # 5th

2. The autonomic nervous system is a
control system that acts largely
unconsciously and regulates bodily
functions such as the heart rate,
digestion, respiratory rate, pupillary
response, urination, and sexual
arousal.
 This system is the primary
mechanism in control of the fight-or-
flight response.

3. The autonomic nervous system is divided into :
I. sympathetic nervous system
II. parasympathetic nervous system
1) The sympathetic division emerges from the spinal
cord in the thoracic and lumbar areas, terminating
around L2-3.
2) The parasympathetic division has craniosacral
“outflow”, meaning that the neurons begin at
the cranial nerves (specifically the oculomotor
nerve, facial nerve, glossopharyngeal
nerve and vagus nerve) and sacral (S2-S4) spinal
cord.

4. The autonomic nervous system is unique
in that it requires a sequential two-
neuron efferent pathway; the
preganglionic neuron must first synapse
onto a postganglionic neuron before
innervating the target organ.
The preganglionic, or first, neuron will
begin at the “outflow” and will synapse at
the postganglionic, or second, neuron's
cell body. The postganglionic neuron will
then synapse at the target organ.

6.  Autonomic nerves travel to organs throughout the
body.
 Most organs receive parasympathetic supply by
the vagus nerve and sympathetic supply
by splanchnic nerves.
 The sensory part of the latter reaches the spinal
column at certain spinal segments. Pain in any
internal organ is perceived as referred pain, more
specifically as pain from
the dermatome corresponding to the spinal
segment.

8.  Sympathetic and parasympathetic divisions
typically function in opposition to each
other.
 But this opposition is better termed
complementary in nature rather than
antagonistic.
 For an analogy, one may think of the
sympathetic division as the accelerator and
the parasympathetic division as the brake.

9. The sympathetic division typically
functions in actions requiring quick
responses.
The parasympathetic division functions
with actions that do not require immediate
reaction.
The sympathetic system is often
considered the "fight or flight" system .
The parasympathetic system is often
considered the "rest and digest" or "feed and
breed" system.

10.  Sensory neurons, also known as afferent neurons,
are neurons in the central nervous system, that convert a
specific type of stimulus, via their receptors, into action
potentials or graded potentials.
 This process is called sensory transduction.
 The cell bodies of the sensory neurons are located in
the dorsal ganglia of This sensory information travels
along afferent nerve fibers in an afferent or sensory nerve,
to the brain via the spinal cord.
 The stimulus can come from extoreceptors outside the
body, for example light and sound, or
from interoreceptors inside the body, for example blood
pressure or the sense of body position. the spinal cord.

12. A motor neuron (or motoneuron) is
a neuron whose cell body is located in
the motor cortex, brainstem or
the spinal cord, and whose axon (fiber)
projects to the spinal cord or outside of
the spinal cord to directly or indirectly
control effector organs,
mainly muscles and glands.

13. ∞There are two types of motor neuron :
i. Upper motor neurons
ii. lower motor neurons
∞Axons from upper motor neurons synapse
onto interneurons in the spinal cord and
occasionally directly onto lower motor neurons.
∞The axons from the lower motor neurons
are efferent nerve fibers that carry signals from
the spinal cord to the effectors.
∞Types of lower motor neurons are alpha
motor neurons, beta motor neurons,
and gamma motor neurons.

15. The enteric nervous system is the intrinsic nervous
system of the gastrointestinal system. It has been
described as "the Second Brain of the Human
Body".
Its functions include:
a. Sensing chemical and mechanical changes in the
gut.
b. Regulating secretions in the gut.
c. Controlling peristalsis and some other
movements.

16. EXAMINATION OF
AUTONOMIC NERVOUS
SYSTEM

17. € Assessment of the autonomic nervous system
involves checking for the following:
I. Postural hypotension.
II. Heart rate changes in response to the Valsalva
maneuver.
III. Decreased or absent sweating.
IV. Evidence of Horner syndrome (unilateral
ptosis, pupillary constriction, facial
anhidrosis).
V. Disturbances of bowel, bladder, sexual, and
hypothalamic function should be noted.

18.  Your doctor will diagnose orthostatic
hypotension if you have a drop of 20
millimeters of mercury (mm Hg) in
your systolic blood pressure or a drop
of 10 mm Hg in your diastolic blood
pressure within two to five minutes of
standing up, or if standing causes signs
and symptoms. Blood tests.

20. The Valsalva maneuver is
performed by moderately
forceful attempted
exhalation against a closed
airway, usually done by
closing one's mouth,
pinching one's nose shut

22. Horner syndrome is a combination of
signs and symptoms caused by the
disruption of a nerve pathway from the
brain to the face and eye on one side of
the body.
Typically, Horner syndrome results in
a decreased pupil size, a drooping
eyelid and decreased sweating on the
affected side of your face.

24. LESIONS OF
AUTONOMIC
NERVOUS
SYSTEM

25. Autonomic dysfunction can affect a
small part of the ANS or the entire ANS.
Some symptoms that may indicate the
presence of an autonomic
nerve disorder include: dizziness and
fainting upon standing up, or
orthostatic hypotension. an inability to
alter heart rate with exercise, or
exercise intolerance.

26. Autonomic dysfunction develops when the nerves
of the ANS are damaged.
This condition is called autonomic neuropathy or
dysautonomia.
Autonomic dysfunction can range from mild to life-
threatening. It can affect part of the ANS or the
entire ANS.
Sometimes the conditions that cause problems
are temporary and reversible. Others are chronic,
or long term, and may continue to worsen over
time.
Diabetes and Parkinson’s disease are two
examples of chronic conditions that can lead to
autonomic dysfunction.

27.  Autonomic dysfunction can affect a small part of the ANS or
the entire ANS. Some symptoms that may indicate the
presence of an autonomic nerve disorder include:
 dizziness and fainting upon standing up, or orthostatic
hypotension
 an inability to alter heart rate with exercise, or exercise
intolerance.
 sweating abnormalities, which could alternate between
sweating too much and not sweating enough.
 digestive difficulties, such as a loss of
appetite, bloating, diarrhea, constipation, or difficulty
swallowing.

28. urinary problems, such as difficulty starting
urination, incontinence, and incomplete emptying of the
bladder
sexual problems in men, such as difficulty with
ejaculation or maintaining an erection
sexual problems in women, such as vaginal
dryness or difficulty having an orgasm
vision problems, such as blurry vision or an inability of
the pupils to react to light quickly
You can experience any or all of these symptoms
depending on the cause, and the effects may be mild to
severe.
Symptoms such as tremor and muscle weakness may
occur due to certain types of autonomic dysfunction.

29. I. Postural orthostatic tachycardia
syndrome (POTS).
II. Neurocardiogenic syncope (NCS).
III.Multiple system atrophy (MSA).
IV.Hereditary sensory and autonomic
neuropathies (HSAN).
V. Holmes-Adie syndrome (HAS).

30. Other types of autonomic dysfunction can result
from disease or damage to your body. Autonomic
neuropathy refers to damage to nerves from certain
medications, injury, or disease. Some diseases
causing this neuropathy include:
•uncontrolled high blood pressure
•long-term heavy drinking
•diabetes
•autoimmune disorders
Parkinson’s disease can cause orthostatic
hypotension and other symptoms of ANS damage.
This often causes significant disability in individuals
with this disease.

31.  Your doctor will treat autonomic dysfunction by addressing
the symptoms. If an underlying disease is causing the
problem, it’s important to get it under control as soon as p
elevating the head of your bed.
 drinking enough fluids.
 adding salt to your diet.
 wearing compression stockings to prevent blood pooling in
your legs.
 changing positions slowly.
 taking medications like midodrine.
 Nerve damage is difficult to cure. Physical therapy, walking
aids, feeding tubes, and other methods may be necessary to
help treat more severe nerve involvement.

32.  Finding support to help you cope with
autonomic dysfunction can be just as
important for improving quality of life
as managing physical symptoms.
 Methods for coping and improving
quality of life include the following:
 Depression can occur with autonomic
dysfunction. Therapy with a qualified
counselor, therapist, or psychologist

33. Ask your doctor or therapist about
support groups in your area. They’re
available for different conditions.
You may find that you have more
limitations than before your diagnosis.
Set priorities to help you make sure
you’re doing the things that are
important to you.
Accept help and support from family
and friends if you need it.
Ask for help if you need it.

34. THANK
YOU