The clinical spectrum of autonomic dysfunction

Classic cases of idiopathic autonomic dysfunction are easily recognized, but certain presentations may not immediately suggest the diagnosis. Among 297 cases in the experience of our institutions, eight have been selected as illustrative of the difficulties which may be encountered. The disorder may present as angina pectoris, Parkinsonism, night blindness, nasal stuffiness, malignant hypertension, postprandial fainting, intracerebral hemorrhage and respiratory arrest. About half of the patients with idiopathic orthostatic hypotension manifest supine hypertension. These subjects are extremely sensitive to pressor and depressor agents; those who have angina pectoris complicating their disease are characteristically worsened by nitroglycerin.