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Autonomic nerve symptoms Assessment Questionnaire

Questions Your Doctor May Ask - and Why!

During a consultation, your doctor will use various techniques to assess the symptom: Autonomic nerve symptoms. These will include a physical examination and possibly diagnostic tests. (Note: A physical exam is always done, diagnostic tests may or may not be performed depending on the suspected condition) Your doctor will ask several questions when assessing your condition. It is important to openly share any pertinent information to help your doctor make an accurate diagnosis.

It is also very important to bring an up-to-date list of all of your all medical conditions, medications including dosages, and names of numbers of any specialist you see.

Create your printable checklist by answering questions that your doctor may ask below:

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  1. Have you or anyone in your family ever been diagnosed with or tested for diabetes mellitus?

    Why: Diabetes can cause autonomic neuropathy, particularly when it goes undetected/undiagnosed or is poorly managed/controlled. Diabetes is a condition which tends to have an inheritable component, and so you may be at increased risk of developing it if members of your family have it. It can be tested for relatively quickly and easily, though a negative test does not mean that you won't develop it in the future.

  2. Do you take any regular medications?

    Why: Some medications can predispose to the development of autonomic neuropathy, such as tricyclic antidepressants and L-dopa.

  3. Have you ever been diagnosed with or treated for depression?

    Why: Some classes of medication which are commonly utilized in the management of depression can predispose you to developing autonomic neuropathy.

  4. Have you or anyone in your family ever been diagnosed with or treated for Parkinson's syndrome?

    Why: Some of the medications which may be used in the management of Parkinson's syndrome may cause autonomic neuropathy. Additionally, the symptoms experienced with Parkinson's syndrome may also be experienced in a rarer condition called Shy Drager syndrome which causes more widespread neurological dysfunction, including autonomic neuropathy. Thus if in addition to the symptoms of autonomic neuropathy, you or any of your family members have been diagnosed with Parkinson's syndrome or any of its symptoms, it is important for you to tell your health professional as otherwise this uncommon diagnosis may not be made.

  5. Have you ever been diagnosed with craniopharyngioma or any cancers?

    Why: Craniopharyngioma is a cancer which occurs within the skull, causes pituitary gland dysfunction, and may also result in autonomic neuropathy.

  6. Have you ever been diagnosed with any vascular disease?

    Why: Vascular disease of many different types and causes can lead to the development of autonomic neuropathy.

  7. Have you ever been diagnosed with any back disorders or spinal cord disorders?

    Why: Disorders which affect your spinal cord can cause you to develop autonomic neuropathy.

  8. Have you ever been diagnosed with syphilis or thought that you might have contracted it?

    Why: There are several stages which may be experienced by patients who have syphilis, with one of the latter stages being tertiary syphilis (also known as neurosyphilis). The late-stage syphilis can cause spinal cord dysfunction known as tabes dorsalis which may be experienced as autonomic neuropathy. As this stage of syphilis can be up to (or later than) 2 decades after it was initially contracted, it is important for you to mention any instances in the past when you may have contracted it, such as unprotected sexual intercourse.

  9. Have you ever been diagnosed with Chagas' disease or trypanosomiasis, or traveled to Africa or Central/South America?

    Why: This condition is also known as sleeping sickness and may result in autonomic neuropathy. It is a protozoan parasite transmitted by insects which can result in both acute and chronic/delayed symptoms such as fever, lymphadenopathy, enlarged liver or spleen (hepatosplenomegaly), skin rash, headache, sexual dysfunction, menstrual dysfunction, ascites, nephritis, cardiac tamponade/pericardial effusion, weight loss, joint pain (arthralgia), depression, difficulty with walking or movements (ataxia/dyskinesia), dementia, sleepiness (hypersomnolence), conjunctivitis, myocarditis, meningoencephalitis, cardiomyopathy, megacolon, megaesophagus, oedema, or coma. It is very important to remember however that this condition is endemic only in Africa, Central American and South America. As such, it is an unlikely that you have it unless you have ever traveled to those areas.

  10. Have you ever been diagnosed with, been tested for, or think that you might have been at risk of contracting human immunodeficiency virus/acquired immunodeficiency syndrome?

    Why: Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) can result in autonomic neuropathy, either directly or as a result of increasing the likelihood of other conditions such as Chagas' disease. HIV/AIDS can have many other affects on your health and it is important that it is diagnosed and managed as early as possible. As such, it is important that you disclose any high risk activities or behaviors that you have ever taken part in. These can include unprotected sex, anal intercourse, sexual intercourse with a person you think may be at risk of contracting HIV/AIDS or take part in any of the high risk activities/behaviors listed here, intravenous drug use (injected by yourself or others), needlestick injuries, or contact with infectious materials (blood, tissue, etc.). It is important to remember that all consultations you have with health professionals are strictly confidential and your privacy will be protected as outlined in the law of your country/state of residence.

  11. Has anyone in your family ever been diagnosed with autonomic neuropathy/familial dysautonomia/Riley Day syndrome?

    Why: This is a genetically inheritable condition which can cause autonomic neuropathy and some specific neurological symptoms such as impaired pain sensation, impaired taste sensation, motor incoordination, frequent bronchial pneumonia, emotional instability, and non-tolerance of anaesthetic agents.

  12. Can you tell me a bit about your family's ethnic background?

    Why: There are some ethnic groups which can have an increased risk of inheriting conditions which may cause autonomic neuropathy. One such specific ethnic background is that of Ashkenazi Jewish peoples.

  13. Has anyone in your family ever been diagnosed with Shy Drager syndrome?

    Why: This is a genetically inheritable but uncommon syndrome causing autonomic neuropathy with Parkinsonian symptoms.

  14. Have you or anyone in your family ever experienced any abnormal or absent sensation (paraesthesia), problems with movement/weakness (motor dysfunction), or ever been diagnosed with polyneuropathy?

    Why: Polyneuropathy is caused by dysfunction of sensory nerves, motor nerves, autonomic nerves, or any combination of these. There are many conditions which can cause polyneuropathy including Guillain Barré syndrome, lead poisoning, Charcot Marie Tooth syndrome, diabetes mellitus, uremia/renal failure/renal disease, leprosy, sarcoidosis, chronic inflammatory demyelinating polyneuropathy, hypothyroidism, hypoglycemia, mitochondrial syndromes/mitochondrial disorders, rheumatoid arthritis, Wegener's granulomatosis, polyarteritis nodosa, cancers/paraneoplastic syndrome, syphilis, Lyme disease, human immunodeficiency virus, alcoholism, porphyria, vitamin deficiencies, Refsum's syndrome, paraproteinemia/multiple myeloma/amyloidosis, and many medications (phenytoin, isoniazid, metronidazole, vincristine, nitrofurantoin, cisplatin). Whilst this is a seemingly impossible list to remember, some of these conditions can have an inheritable or genetic component and so any relevant family history you can impart may be quite important.

  15. How old are you?

    Why: Autonomic neuropathy tends to occur more with increasing age, regardless of the presence or absence of any condition which may predispose to its development. Your health professional is not asking this question to be ageist or to embarrass you in any way, but rather to assess the risk that in fact you age may be a cause for your symptoms.

  16. Have you experienced any fainting or dizziness after standing up, after eating, after exercise, or after having a hot bath?

    Why: This pattern of "faints" can indicate postural hypotension which is one of the key symptoms of autonomic neuropathy.

  17. Have you experienced erectile dysfunction/sexual dysfunction/impotence?

    Why: This can occur in men with autonomic neuropathy as a result of dysfunction of the autonomic nerves controlling blood flow in and around the sexual organs.

  18. Have you noticed that you are not sweating as much as you might expect that you would?

    Why: Abnormally Decreased sweating/anhidrosis/adiaphoresis can be a symptom experienced with autonomic neuropathy.

  19. Have you noticed that you tend to sweat more than usual during or after eating (gustatory sweating)?

    Why: This can be a symptom of autonomic neuropathy and can occur on a back ground of decreased sweating between meals/eating.

  20. Do you find that you might have episodes of increased sweating which are unrelated to anything else such as eating, heat, hypoglycemia (in diabetic patients), or other things that you might expect to make you sweat more?

    Why: Nocturnal diaphoresis can be a symptom of autonomic neuropathy.

  21. Have you experienced any diarrhea, particularly at night (nocturnal diarrhea)?

    Why: Diarrhea, particularly when experienced at night, can be caused by autonomic neuropathy. It is important to remember that constipation can also occur between episodes of diarrhea when it is caused by autonomic neuropathy.

  22. Have you experienced any constipation or change in bowel habit?

    Why: Constipation alone or between episodes of diarrhea can be a symptom of autonomic neuropathy.

  23. Have you noticed yourself going to the toilet less frequently, having difficulty urinating, urinary incontinence, or recurrent urinary tract infection?

    Why: These may indicate urinary retention which can occur as a result of autonomic neuropathy.

  24. Have you noticed one of your pupils seeming smaller than the other (meiosis), one eye appearing "sunken" (enophthalmos), one eyelid "drooping" abnormally (ptosis), or less sweating than usual on your forehead (anhydrosis)?

    Why: This group of symptoms is together called Horner's syndrome, and whilst it sounds quite obscure it can be caused by a relatively large number of conditions including autonomic neuropathy.

  25. Have you experienced any nausea or vomiting?

    Why: These symptoms can be quite unpleasant and may occur with autonomic neuropathy as a result of abnormally diminished gastric movements/motility (gastroparesis).

  26. Have you had any difficult with your ability to swallow (dysphagia)?

    Why: Dysphagia can be a symptom of autonomic neuropathy as a result of impaired movement and function of your esophagus.

  27. Do you tend to feel abnormally "full" after eating small or drinking small amounts of food or fluid (satiety)?

    Why: This can be a symptom which is vaguely felt, but can be caused by autonomic neuropathy.

  28. If you are diabetic, can I please look at your diabetic blood sugar level records? Have you ever had an HbA1C blood test? How has your diabetic control been?

    Why: Poor or worsening diabetic control can be caused by autonomic neuropathy as it interferes with the body's ability to normally digest food. Poor diabetic control can be reflected by your regular blood sugar level recordings, HbA1C results, and by how you in general feel your diabetic control has been.

  29. Have you had any skin lesions or skin fissures on your feet (pedal skin fissures)?

    Why: These can be caused by abnormally increased skin dryness on your feet as a result of autonomic neuropathy. The basis for this skin dryness is decreased sweating/anhidrosis/adiaphoresis, however you are more likely to notice pedal skin fissures before you notice the decreased sweating.

  30. Do your feet ever feel cold or cooler than usual?

    Why: Autonomic neuropathy can result in your feet feeling cold. This is caused by dysfunction of your skin's temperature regulation mechanism; the skin vasomotor response.

  31. Have you noticed any puffiness or swelling of your ankles (dependant peripheral oedema)?

    Why: This can occur with autonomic neuropathy.

  32. Have you had any large fluid filled "blisters" (bullae)?

    Why: Autonomic neuropathy can predispose you to the formation of these large blister-looking skin lesions.

Conditions listing medical symptoms: Autonomic nerve symptoms:

The following list of conditions have 'Autonomic nerve symptoms' or similar listed as a symptom in our database. This computer-generated list may be inaccurate or incomplete. Always seek prompt professional medical advice about the cause of any symptom.

Select from the following alphabetical view of conditions which include a symptom of Autonomic nerve symptoms or choose View All.

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Conditions listing medical complications: Autonomic nerve symptoms:

The following list of medical conditions have 'Autonomic nerve symptoms' or similar listed as a medical complication in our database.

 

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