Autonomic Neuropathy and the Heart in Diabetes
Grant N. Pierce, Robert E. Beamish, Naranjan S. Dhalla in Heart Dysfunction in Diabetes, 2019
On the basis of NE uptake, storage, metabolism, and release, many investigators have implicated the involvement of the sympathetic nervous system in the pathophysiology of several heart diseases.73–75 While these results favor the view that the sympathetic nervous system is activated in diabetes, the significance of such a lesion in the development of diabetic cardiomyopathy and associated changes in the ultrastruucture and function of subcellular organelles64,76,77 remains to be investigated. In this regard, insulin plays a crucial role in the regulation of sympathetic activity because most of the changes of NE stores, synthesis, uptake, release, and metabolism observed in diabetes are reversible upon insulin treatment.53,58 It should be noted that there is a close correlation between the development of diabetic cardiomyopathy and the rise in cardiac NE level as both of these defects are shown to occur 4 weeks after the injection of streptozotocin.77 At any rate, it would appear that the sympathetic nervous system is activated during the early stages of experimental diabetes. Autonomic neuropathy is preceded by this increased activity of the sympathetic nervous system and this abnormality may play a crucial role in the cellular damage in cardiac muscle.
Clinical Presentation of the Lightning Victim
Christopher J. Andrews, Mary Ann Cooper, Mat Darveniza, David Mackerras in Lightning Injuries: Electrical, Medical, and Legal Aspects Editors, 1992
Immediately after the lightning strike, there may be a variety of temporary and sometimes enduring pupillary abnormalities. These include dilated, nonreacting pupils (which in the presence of cardiorespiratory arrest may be mistakenly interpreted as indicating irretrievable brain death33), Homer’s syndrome, anisocoria, and pupillary myotonia. There may also be temporary sensory symptoms, e.g., painful paresthesiae, particularly involving the limbs.26 The majority of victims of lightning injury who regain consciousness are left with no long-term neurological sequelae, but temporary or permanent neurological disorders may occur, e.g., decerebrate rigidity,66 aphasia,30 and headache. All the latter may exist in the absence of abnormal neurological signs.30,35,67 Delayed onset neurological sequelae (to be discussed below) may develop occasionally. Autonomic neuropathy, i.e., disturbances in unconscious automatic body functions due to damage to the nerves controlling them, may be found.30,63
Diabetic Neuropathy
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
To resolve autonomic neuropathy, the underlying cause must be treated. Patients should follow physician instructions about managing their diabetes – the blood glucose, BP, and cholesterol. This can stop the nerve damage from progressing. Measures used for treatment include more physical activity, increased salt in the diet if there is orthostatic hypotension, increasing hydrating fluids, raising the head of the bed, wearing elastic stockings to improve blood flow, rising up from sitting to standing slowly, and avoiding hypoglycemia. Medications may be prescribed to help the body retain salt, increase BP, and regulate the heart rate. Dietary changes may be needed, and some patients require OTC medications to treat constipation, diarrhea, and fecal incontinence. For bladder problems, prescription medications may be needed, such as antibiotics for bladder infections.
Possible roles of mitochondrial dysfunction in neuropathy
Published in International Journal of Neuroscience, 2021
Chutikorn Khuankaew, Passakorn Sawaddiruk, Poomarin Surinkaew, Nipon Chattipakorn, Siriporn C. Chattipakorn
Neuropathy is a pathological pain in which the function of the nervous system has been disturbed [1,2]. Neuropathy is commonly found with different underlying pathophysiological conditions, including trauma-induced neuropathy, chemotherapy-induced neuropathy, diabetes-induced neuropathy and HIV-associated sensory neuropathy. Neuropathy may affect the sensory, motor or autonomic nervous system which causes suffering in many patients [1,2]. Sensory neuropathy may present neuropathic pain with abnormal sensations such as numbness or changes in the ability to detect heat and cold, whereas muscle weakness, cramps or paralysis are found in patients with motor neuropathy [1]. In addition, autonomic neuropathy may result in abnormal feelings such as dizziness and fainting due to sudden changes in blood pressure, abnormal sweating, incontinence or impotence [2]. The exact pathophysiology of neuropathy is still unclear. Although currently neuropathy cannot be cured, symptomatic therapy has been used to relieve pain in these patients. It is expected that the underlying aetiology of neuropathy should be identified to be targeted for the future therapy.
Hereditary transthyretin amyloidosis: baseline characteristics of patients in the NEURO-TTR trial
Published in Amyloid, 2018
Marcia Waddington-Cruz, Elizabeth J. Ackermann, Michael Polydefkis, Stephen B. Heitner, Peter J. Dyck, Fabio A. Barroso, Annabel K. Wang, John L. Berk, P. James B. Dyck, Brett P. Monia, Steven G. Hughes, Li Tai, T. Jesse Kwoh, Shiangtung W. Jung, Teresa Coelho, Merrill D. Benson, Morie A. Gertz
Presence of autonomic neuropathy, as reported by patients, was consistent with the NSC results. Over 50% of patients had a history of gastrointestinal manifestations, which are generally attributed to deficits in the autonomic nervous system. GI amyloidosis or symptoms, such as recurring diarrhea, constipation, defecation urgency, GI mobility disorder, or GI hypomotility were reported in 80 (47%) patients; nausea, vomiting, or early satiety in 23 (13%) patients; and unintentional weight loss (abnormal loss of weight, weight decreased, cachexia, decreased appetite) in 31 (18%) patients. In addition, 61 (35%) patients reported a history of either orthostatic hypotension, sexual dysfunction, urinary tract infection (UTI), urinary retention/hesitation/incontinence or neurogenic bladder.
Autoimmune autonomic ganglionopathy: an update on diagnosis and treatment
Published in Expert Review of Neurotherapeutics, 2018
Shunya Nakane, Akihiro Mukaino, Osamu Higuchi, Mari Watari, Yasuhiro Maeda, Makoto Yamakawa, Keiichi Nakahara, Koutaro Takamatsu, Hidenori Matsuo, Yukio Ando
Totally, 11 patients (14%) exhibited the following endocrine disorders: amenorrhea (n = 5), syndrome of inappropriate antidiuretic hormone secretion (SIADH) (n = 2), hyponatremia (n = 3), adrenal insufficiency (n = 1) and panhypopituitarism (n = 1). Several Japanese neurologists have already reported cases of APD or acute autonomic and sensory neuropathy with amenorrhea and/or SIADH [41–43]. They have suggested that patients with autonomic neuropathy might have both peripheral and CNS manifestations. nAChRs are associated with cholinergic neurotransmission, modulation of dopamine function, inflammation, and activity of the hypothalamic-pituitary-adrenal axis [44,45]. We presumed that nAChRs are involved in a variety of neurological systems that are implicated in the pathophysiology of CNS involvement including endocrine disorders and psychiatric symptoms.