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Neurology (Expert Forum)
autoimmune autonomic neuropathy
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autoimmune autonomic neuropathy
by Annie62, Dec 30, 2006 12:00AM
44-y.o. woman just given tentative dx at Mayo (waiting to hear) of autoimmune autonomic neuropathy with possible CIDP. Went for MS eval and instead got worked up for auton. dysfunction. 1st symptom I had was in '90-Horner's syndrome with left-sided anhidrosis, ptosis, constricted pupil. Felt fine then. Went to neuro who only did CXR/told me it was probably benign-took his word for it. Anhid./ptosis lasted 2 years, small pupil only few months. In '94 actually GOT sick; about month after RTI got onset of constant right-sided chest pain that spread to left/low-grade daily fever lasted 6 months, faintness, bradycardia, chest became weak/breathing slowed down-felt very ill. I felt like I had to make my chest go up/down myself/mechanical thing. Chest sympt. lasted approx 1 1/2 years before tapering off to partial remission. In '98 right side of mouth started drooping/right eye became blurred. '99 got bad bact./intest. infection and IMMEDIATELY symptoms (except Horner's) returned full-force--more chest discomfort/tenderness than actual pain this time, faintness, slowed breathing. 2 1/2 months later left arm/leg became mildly weak/dragged, trouble swallowing (left-sided thumping in throat), slurred speech. Extreme exacerba. every month with ovulation, once with sudden partial paralysis, slowed/shallow breathing, slurred speech. 5 years ago decreased sensation sexually/urge to pee/occas. incontinence (no retention). August just dxd with severe gastroparesis-doctors FINALLY believe I am actually ill. What is prognosis for untreated AAN? Angry and scared. Thank you.
Doctor's Answer
by CCF-Neuro-M.D.-SH, Jan 24, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
Many of the symptoms that you describe are consistent with autonomic dysfunction including gastroparesis, Horners syndrome, bradycardia, faintness, bowel/bladder problems and swallowing difficulties. Your problems with left sided weakness and chest pain is a little harder to fit with AAN. Autoimmune autonomic neuropathy occurs when your bodies immune system makes antibodies that attack your autonomic nervous system. This can be in several different isease types/forms. One instance this occurs in is Guillain-Barre syndrome (GBS) which also cuases an accending paralysis of the body (feet affected first, then arms and finally respiratory muscles). The course for GBS is generally short (an acute disease) with onset/progression of symptoms over 3 days-1 week. In addition to the ascending paralysis it also attacks the autonomic system causing many of the ailments that you have. However, since your course has been more chronic it is less likely to be GBS. Another possibility is chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), which can also have associated autonomic dysfunction (although less often than with GBS). CIDP can cause a chronic relapsing and progressive loss of motor functions, patchy sensory loss and most of all- chronic pain. CIDP can be treated with steroids, IVIG and plasma exchange, depending on the severity. Another possibility that must be consisdered is the possible presence of a paraneoplastic antibody (which can also give you a CIDP-autonomic dysfunction type picture). Paraneoplastic antibodies are your bodies immune response against a cancer (most common is lung, but can be any type of cancer). The antibodies inaddition to fighting the cancer, also attack your nervous system and cause problems such as AAN. The course for patients with paraneoplastic syndromes is often short (acute) and devestating. Thus, given your chronic history, I think this is less likely (but I would recommend a CT scan with contrast of the chest/abdomen and pelvis, a mamogram and a colonoscopy to screen for cancers).
I hope this has been helpful
Many of the symptoms that you describe are consistent with autonomic dysfunction including gastroparesis, Horners syndrome, bradycardia, faintness, bowel/bladder problems and swallowing difficulties. Your problems with left sided weakness and chest pain is a little harder to fit with AAN. Autoimmune autonomic neuropathy occurs when your bodies immune system makes antibodies that attack your autonomic nervous system. This can be in several different isease types/forms. One instance this occurs in is Guillain-Barre syndrome (GBS) which also cuases an accending paralysis of the body (feet affected first, then arms and finally respiratory muscles). The course for GBS is generally short (an acute disease) with onset/progression of symptoms over 3 days-1 week. In addition to the ascending paralysis it also attacks the autonomic system causing many of the ailments that you have. However, since your course has been more chronic it is less likely to be GBS. Another possibility is chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), which can also have associated autonomic dysfunction (although less often than with GBS). CIDP can cause a chronic relapsing and progressive loss of motor functions, patchy sensory loss and most of all- chronic pain. CIDP can be treated with steroids, IVIG and plasma exchange, depending on the severity. Another possibility that must be consisdered is the possible presence of a paraneoplastic antibody (which can also give you a CIDP-autonomic dysfunction type picture). Paraneoplastic antibodies are your bodies immune response against a cancer (most common is lung, but can be any type of cancer). The antibodies inaddition to fighting the cancer, also attack your nervous system and cause problems such as AAN. The course for patients with paraneoplastic syndromes is often short (acute) and devestating. Thus, given your chronic history, I think this is less likely (but I would recommend a CT scan with contrast of the chest/abdomen and pelvis, a mamogram and a colonoscopy to screen for cancers).
I hope this has been helpful
Autoimmune autonomic neuropathy and Horner's syndrome with left-sided anhidrosis, ptosis, constricted pupil
Borrelia burgdorferi?
constant right-sided chest pain that spread to left/low-grade daily fever lasted 6 months, faintness, bradycardia
Bartonelliosis?
chest became weak/breathing slowed down-felt very ill. I felt like I had to make my chest go up/down myself/mechanical thing
Babesiosis?
right side of mouth started drooping/right eye became blurred
Bell's (cranial nerve) palsy- Borrelia burgdorferi?
bad bact./intest. infection