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The Autonomic Laboratory at University Hospitals of Cleveland is the only facility of its kind in Ohio and surrounding states. Using state-of-the-art equipment, the lab offers non-invasive testing that evaluates abnormalities in the control of blood pressure, heart rate, urination, digestion, sexual function, and sweating. Testing, intended for patients over the age of 1, helps to diagnose a wide variety of autonomic disorders, enabling the referring physician to provide appropriate and specific treatment.
Autonomic testing will accurately and reliably establish whether the autonomic nervous system is the cause of any of the symptoms below:
Syncope is due to an abnormality of the autonomic nervous system in 75 percent of patients who do not have obvious heart disease or a seizure disorder.
Radicular thoracic and abdominal pain are common in diabetics or may be caused by infectious (herpes zoster) or mechanical (intervertebral disk herniation) processes. The sweat test confirms the diagnosis of radiculopathy by revealing a failure to sweat in the involved dermatome.
Sexual dysfunction may be the initial manifestation of disorders affecting much of the autonomic nervous system. Autonomic function tests can directly estimate the extent of involvement of the sympathetic and parasympathetic nervous systems. This is especially important in evaluating diabetics and other patients with erectile dysfunction who may have both organic and psychogenic etiologies.
Disorders of bowel motility, including achalasia, intestinal pseudo-obstruction, chronic recurrent abdominal pain, cyclic vomiting, and unexplained diarrhea or constipation, have been increasingly linked to generalized autonomic abnormalities.
Urinary retention or frequency may be the first symptom of autonomic nervous system disease.
Sweating abnormalities, such as essential hyperhidrosis, heat intolerance and other disorders producing excessive or inadequate sweating, can be measured directly by autonomic tests which include quantitative sweat monitoring.
Silent cardiac ischemia (in diabetes) may be due to autonomic impairment. Because moderate dysautonomia may produce few symptoms, it may remain undiagnosed without autonomic testing.
Autonomic testing is the definitive test for several conditions:
Small fiber neuropathy may cause burning dysesthesia and reduced sensitivity to pinprick and temperature sensation in the patient's feet, or more disabling autonomic symptoms. Causes include diabetes, amyloidosis, and immune-mediated processes such as paraneoplastic and Guillain-Barre syndromes. Nerve conduction studies and standard electromyography are entirely ineffective in recognizing abnormalities restricted to small fibers.
Reflex sympathetic dystrophy causes a patient to experience severe burning pain, hypersensitivity to touch, swelling, skin color changes, and abnormalities of skin texture, hair, nails, and bones. This syndrome can be difficult to recognize on clinical grounds, but specific abnormalities in sweating and skin temperature can provide a diagnosis with high specificity, and can direct appropriate therapy.
Postural orthostatic tachycardia syndrome occurs when orthostatic symptoms are accompanied by unexplained tachycardia. The disorder is common in young women, but may occur in others. Correct recognition of the problem with autonomic testing can prevent unneccessary procedures such as radiofrequency cardiac ablations or pacemaker placement.
Chronic fatigue syndrome may result from chronic orthostatic hypotension. Testing identifies patients who will benefit from treatment of orthostasis, allowing many to return to a normal, productive lifestyle.
Multiple system atrophy (Shy-Drager syndrome) causes a slowing of motor function and paucity of movement, along with significant autonomic symptoms. These symptoms may include constipation, erectile dysfunction, bladder dysfunction, or orthostatic hypotension.
Pure autonomic failure may occur in isolation, causing heat intolerance, urinary retention, or orthostatic hypotension.
Depending on the reason for referral, autonomic testing for a patient involves five to seven noninvasive tests and requires a two to three-hour visit. These tests, which measure cardiac response, sweating, and blood flow, include:
Cardiovascular Response Tests
(with noninvasive, continuous blood pressure monitoring)
Deep Breathing
Valsalva Maneuver
Lower body Negative Pressure
Upright Tilt
Hand grip
Sweat Tests
(with direct quantification of sweat production)
Resting Sweat Output
Axon Reflex Sweat Output
Thermoregulatory Sweat Test
Blood Flow Tests
Skin Blood Flow by laser doppler
Deep Muscle Blood Flow by plethysmography
Limb Volume by water displacement
Skin Temperature by infrared thermography
Our staff works to make your patient's visit a pleasant one. Besides tending to your patient's personal comfort, we explain procedures in detail until all questions are answered.
The Autonomic Laboratory at University Hospitals strives to provide technically accurate tests with a clinically relevant interpretation. Interpretations are given directly to the referring physician, unless other arrangements are preferred. To refer patients or learn more about testing, call (216) 844-3496.
Thomas Chelimsky, MD, director of the Autonomic Laboratory, joined University Hospitals of Cleveland in 1990. A graduate of Harvard College, Dr. Chelimsky earned his medical degree at Washington University in St. Louis. He completed residencies in internal medicine and neurology at the Mayo Clinic in Rochester, Minnesota. There, he also received special training in clinical autonomic physiology and testing. Dr. Chelimsky has published articles on reflex sympathetic dystrophy and the physiology of sweating.
Lora Tusing, EMT, coordinator of the Autonomic Laboratory, has been with the Autonomic Lab since 1996. She received her EMT training at Cuyahoga Community College.
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