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Testing the sympathetic nervous system

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There are several ways of testing the integrity of the sympathetic nervous system:

  • postural blood pressure changes: there is normally a slight rise in blood pressure on standing; in patients with sympathetic denervation, there is a marked fall.
  • the Valsalva manoeuvre: there is a temporary fall in blood pressure in patients with autonomic failure.
  • tests of positive efferent sympathetic function:
    • a rise in blood pressure during times of stress or application of an ice-pack.
    • reflex sweating and flushing of skin are still intact

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