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Autonomic Disorders: Clinical Autonomic Disorders: Evaluation and Management

Autonomic Disorders: Clinical Autonomic Disorders: Evaluation and Management Few neurologists have maintained or acquired the breadth of expertise necessary to practice in the complex field of autonomic dysfunction. Phillip Low, chairman of the Division of Clinical Neurophysiology and founder of the autonomic laboratory at the Mayo Clinic, is one of them. Like the first (1993) edition of his text Clinical Autonomic Disorders, the second is a multiauthored survey of current knowledge on diagnosis and treatment of autonomic dysfunction. Clinical Autonomic Disorders demonstrates both the extent of penetration of "autonomic neurology" into fields like cardiology, ophthalmology, gastroenterology, and urology and the quickening pace of progress in understanding human autonomic physiology. For this reasonably comprehensive survey of the subject, authors had to be tapped from departments of anesthesiology, internal medicine, urology, physiology, and dermatology as well as neurology. An introductory chapter providing the editor's classification of clinical autonomic disorders reveals the wide variety of diseases and circumstances associated with autonomic dysfunction and offers a systematic clinical approach to the evaluation of the patient with autonomic symptoms. He includes a useful investigational approach to the patient with orthostatic hypotension, while his diagnostic "autonomic symptom profile" is nicely described but not included in the book. The next and shortest section reviews the basic anatomy and physiology of the autonomic system. This section alone could constitute a respectable textbook on the subject. The chapter "Maintenance of Postural Normotension in Humans" is a particularly concise and cogent summary of a complex subject. An excellent new chapter considers the effect of aging on the autonomic nervous system, particularly on baroreceptor reflexes. The rest of the book focuses on techniques of evaluation of autonomic function and on the clinical features, diagnosis, and treatment of various autonomic disorders. Dr Low's chapter "Laboratory Evaluation of Autonomic Function" includes his own carefully compiled age-related norms for noninvasive autonomic reflex tests, which may be useful to clinicians. Other chapters, such as the ones on diabetic autonomic neuropathy and on management of the autonomic storm, will also be helpful to the clinician, but many, eg, those on time-frequency analysis of cardiovascular function and on conditions of reduced gravity, will interest only the initiated. Although some chapters, such as the one on management of orthostatic hypotension, offer useful discussion of practical treatment options, readers looking for a succinct how-to book on bedside diagnosis and treatment of common autonomic problems should look elsewhere. For example, the chapter "Evaluation of Pupillary and Lacrimal Function" describes no pharmacological tests of pupillary functions, and it takes careful searching through "Autonomic Disorders of the Pupil, Ciliary Body, and Lacrimal Apparatus" to discover simple office methods of evaluating the cause of anisocoria. Like the first edition, this one is nicely produced. The graphs, diagrams, and figures are clear and pertinent, and several color plates are beautifully done. Clinical Autonomic Disorders will serve as a useful reference book for the neurologist, internist, clinical neurophysiologist, or other specialist with a particular interest in the subject. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Autonomic Disorders: Clinical Autonomic Disorders: Evaluation and Management

JAMA , Volume 279 (13) – Apr 1, 1998
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Publisher
American Medical Association
Copyright
Copyright © 1998 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.279.13.1041
Publisher site
See Article on Publisher Site

Abstract

Few neurologists have maintained or acquired the breadth of expertise necessary to practice in the complex field of autonomic dysfunction. Phillip Low, chairman of the Division of Clinical Neurophysiology and founder of the autonomic laboratory at the Mayo Clinic, is one of them. Like the first (1993) edition of his text Clinical Autonomic Disorders, the second is a multiauthored survey of current knowledge on diagnosis and treatment of autonomic dysfunction. Clinical Autonomic Disorders demonstrates both the extent of penetration of "autonomic neurology" into fields like cardiology, ophthalmology, gastroenterology, and urology and the quickening pace of progress in understanding human autonomic physiology. For this reasonably comprehensive survey of the subject, authors had to be tapped from departments of anesthesiology, internal medicine, urology, physiology, and dermatology as well as neurology. An introductory chapter providing the editor's classification of clinical autonomic disorders reveals the wide variety of diseases and circumstances associated with autonomic dysfunction and offers a systematic clinical approach to the evaluation of the patient with autonomic symptoms. He includes a useful investigational approach to the patient with orthostatic hypotension, while his diagnostic "autonomic symptom profile" is nicely described but not included in the book. The next and shortest section reviews the basic anatomy and physiology of the autonomic system. This section alone could constitute a respectable textbook on the subject. The chapter "Maintenance of Postural Normotension in Humans" is a particularly concise and cogent summary of a complex subject. An excellent new chapter considers the effect of aging on the autonomic nervous system, particularly on baroreceptor reflexes. The rest of the book focuses on techniques of evaluation of autonomic function and on the clinical features, diagnosis, and treatment of various autonomic disorders. Dr Low's chapter "Laboratory Evaluation of Autonomic Function" includes his own carefully compiled age-related norms for noninvasive autonomic reflex tests, which may be useful to clinicians. Other chapters, such as the ones on diabetic autonomic neuropathy and on management of the autonomic storm, will also be helpful to the clinician, but many, eg, those on time-frequency analysis of cardiovascular function and on conditions of reduced gravity, will interest only the initiated. Although some chapters, such as the one on management of orthostatic hypotension, offer useful discussion of practical treatment options, readers looking for a succinct how-to book on bedside diagnosis and treatment of common autonomic problems should look elsewhere. For example, the chapter "Evaluation of Pupillary and Lacrimal Function" describes no pharmacological tests of pupillary functions, and it takes careful searching through "Autonomic Disorders of the Pupil, Ciliary Body, and Lacrimal Apparatus" to discover simple office methods of evaluating the cause of anisocoria. Like the first edition, this one is nicely produced. The graphs, diagrams, and figures are clear and pertinent, and several color plates are beautifully done. Clinical Autonomic Disorders will serve as a useful reference book for the neurologist, internist, clinical neurophysiologist, or other specialist with a particular interest in the subject.

Journal

JAMA – American Medical Association

Published: Apr 1, 1998

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