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THE AUTONOMIC NERVOUS SYSTEM ( ANS )
Henny Anggraini Sadeli
Department of Neurology
Medical Faculty Padjadjaran University
Dr. Hasan Sadikin General Hospital Bandung
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The functional devision of the PNS
Innervates smooth and cardiac muscle & the glands ofthe
body
Involuntary
Function
Regulates the vital functions that maintain theinternal
environtment ( homeostasis )
The vital function : respiration
circulation
metabolism
body temperature
water metabolism
digestion
secretion
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Hypothalamus
Controlling or steering the ANS
Rostral portion parasympathetic
Caudal sympathetic
Connect with the descending reticular system ( mid brain )
ANSSympathetic = thoracolumbar ANS
Parasympathetic = craniosacral ANS
Frontal lobe cortex
Amygdaloid Nuclei
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The sympathetic nervous system
For fight, flight or fright
Catabolic, energy expending
Increases heart rate & breathing
Dilates blood vessels in skeletal & cardiac muscles
Constricts blood vessels in GI tract
Dilates the bronchial passages
Dilates the pupils
Piloerection
Increases sweat secretion
Mobilizes glucose
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The parasympathetic nervous system
Dominated during rest
Anabolic, energy conserving
Constricts the pupils
Decreases the heart rate
Increases GI peristalsis & secreation
Expels wates
Contraction of bladder wall
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Neurotransmitters of the ANS
ANS
Cholinergic axons : acethylcholine
Adrenergic axons : norepinephrine
Cholinergic axons
Preganglionic axons of the parasympathetic andsympathetic NS
Post ganglionic neurons of the parasympathetic NS
Post ganglionic axons of the sympathetic NS to the
sweat glands & piloerector muscles
Adrenergic axons
Postganglionic sympathetic axons
Adrenal gland
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TEST OF AUTONOMIC FUNCTION
Sudomotor function
Starch test
Quinarizin, a color indicator
Quantitative sudomotor axon reflex test ( QSART test )
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Hyperhidrosis
CRPS ( Complex Regional Pain Syndrome )
Spinal paraplegic
Peripheral neuropathy
Localized hyperhidrosis
( palm, feet, lower extremities )congenital
sign of nervousness
Anhidrosis
Peripheral nerve disease
Sympathectomy
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Mental arithmetic
blood pressure & pulse rate increases
defect sympathetic NS no response ( central/peripheral )
Alteration of the pupils
+ epinephrine sol ( 1 : 1000 )
no change
sympathetic denervation dilatation
+ cocaine sol 4 %
dilatation
sympathetic denervation no response
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+ atropine 0,8 mg IM
tachycardia
sympathetic denervation of the heart no change
+ neostigmin 1 mg IM
bradycardia
sympathetic denervation no change
+ pilocarpine 0,125 %
no response
parasympathetic denervation meiosis
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Cystometrogram
test of bladder function
Radiologic Barium
test of GI motility
Nocturnal penile tumescence
Posture / tilt table
Recumbent ( 2 ) standing positionAbnormal : S 30 mmHg ( 20 mmHg
)
D 15 mmHg ( 10 mmHg )
Normal : HR 1129 beats / 1
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Hypovolemia orthostatic hypotension
Recurrent fainting : in adequate sympathetic
vasoconstrictor activity
Neurocardiogenic syncope : oversensitive cardiac
reflex vasodilatation
Peripheral neuropathy
Elderly
Failure of the HR to rise vagal nerve dysfunction
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Cold pressor test
Hands in ice water 60
BP : S : 15 20 mmHg
D : 10 15 mmHg
Bradycardia
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