臨床でよく出会う自律神経症状とその解釈

抄録

Orthostatic hypotension (OH), anhidrosis, and pupil abnormalities are clinically common autonomic symptoms. Subjective symptoms of orthostatic hypotension include lightheadedness, fainting, and pale vision. The degree of OH can be measured at the bedside in patients lying supine or standing, using a sphygmomanometer. The pathogenesis of OH can be indicated by assessing positionally related changes in blood pressure and heart rate. Anhidrosis can be indicated by measuring body temperature under warm or hot conditions. Sweating that is insufficient to compensate for increases in body temperature produces unpleasant feelings and abnormally increased body temperature. A poor ability to sweat can be estimated simply by touching dry skin and more precisely determined by generalized thermal sweating tests using the Minor method. Pupil abnormalities can be identified by close examination of the eyes under light and dark conditions. Myosis, ptosis, and anhidrosis in the affected side of a face are the triadic symptoms of Horner syndrome, in which the sympathetic tract from the upper thoracic spinal cord to the eye is disturbed. Remarkable mydriasis can be determined under conditions of light in patients with Adie syndrome, in whom the accommodation reflex remains preserved. These symptoms can be easily assessed at the bedside and should be interpreted appropriately to solve clinical problems associated with the autonomic nervous system.