by Kellie Pokrifka
Throughout this issue, we have discovered the basis for dysautonomia. Now let’s talk about the myriad of ways in which dysautonomia can present itself after brain injury. Note that there are numerous forms of dysautonomia and that each condition can present with different symptoms. To further complicate the diagnosis, each patient can have a unique set of symptoms.
- Temperature Dysregulation – Have you ever noticed you are now constantly cold or always hot? Note that the dysregulation can go both ways, so at one moment you may feel warmer than everyone else in the room, and quickly after, you may feel cooler than everyone else. Keeping a stable, comfortable temperature is an important function that may be compromised due to dysautonomia.
- Sweating/ Sudomotor Dysfunction – An interesting aspect of dysautonomia is its affect on sweating. Some patients have a reduced ability to sweat, which leads quickly to overheating. Some patients notice they are sweating far more than usual. However, if you are considering this aspect, know that many medications prescribed after brain injury can also have over-sweating effects. For example, certain antidepressants and migraine medications can improperly control sweat rates.
- Heart Rate Variability – One of the classic symptoms of dysautonomia is its affects on heart rate. Many patients will find their heart is racing when they are sedentary. Maintaining an increased heart rate when it is not necessary is exhausting to the body. The “tired and wired” feeling of the “fight-or-flight” sympathetic firing is very obvious with this symptom.
- Blood Pressure Dysregulation – Have you noticed dizziness or fainting when you get up after sitting or lying down for an extended period? Do you now become lightheaded if you are just standing for a short period of time? Dysautonomia frequently presents itself with poor regulation of blood pressure, which can lead to dizziness or syncope.
- Pupil Dilation – Dilated pupils indicate sympathetic firing. This can often occur with heightened pain levels. Dysautonomia can skew these levels into dilating improperly without a stimulus.
- Gastroparesis – This is a lack of motion in the muscles used in digestion. The stomach cannot properly move, digest, and empty the food. This can be easily seen if you vomit hours after a meal, and there is still undigested food visible. Gastroparesis can lead to dehydration and malnutrition. Many other gastrointestinal disorders can also arise as a result of dysautonomia, including irritable bowel, constipation, diarrhea, and many others.
- Erectile Dysfunction – The difficulty or inability to get or keep an erection can result from dysautonomia.
These are just a few of the symptoms of dysautonomia. As this condition covers any autonomic process, the presentations are near limitless. In addition, each patient may have a unique cluster of symptoms. Talk with your doctor to see if your set of symptoms may have a basis in dysautonomia.
Kellie is a TBI survivor and works as an intermediary between the experts and the patients with brain injuries.