# Recognizing Debilitating and Fatal Dysautonomia in Patients With Parkinson’s Disease in the Emergency Room: A Case Report and Narrative Review

## TL;DR

This paper highlights how non-motor symptoms like dysautonomia in Parkinson’s disease can lead to severe, life-threatening complications in emergency settings.

## Contribution

The paper presents a case emphasizing the critical role of dysautonomia in PD and advocates for improved emergency recognition and management.

## Key findings

- Dysautonomia-related disorders in PD can lead to frequent emergency visits and fatal outcomes.
- Emergency clinicians should recognize and manage dysautonomia symptoms promptly to prevent complications.
- A holistic approach including palliative care may improve quality of life for advanced PD patients.

## Abstract

Dysautonomia impacts multiple systems leading to a spectrum of severe disorders independent of the motor symptoms in Parkinson’s disease (PD). Although the motor symptoms of dyskinesia and immobility in patients with PD were traditionally considered the major reasons leading to emergency visits, the significance of non-motor symptoms, particularly dysautonomia-related disorders, have been increasingly appreciated during their emergent encounters. We present the case of an elderly patient with advanced PD who was hit by a full spectrum of dysautonomia-related disorders, had frequent emergency visits and hospital admissions over one year, and eventually died on his fifth emergency visit. His dysautonomia-related disorders included dysphagia, gastroesophageal reflux disease, neurogenic bladder, chronic constipation, and cardiac dysautonomia with orthostatic intolerance. We further review emergent presentations, assessments, and immediate management of these dysautonomia-associated disorders in patients with PD. In summary, these dysautonomia-linked comorbidities can be debilitating and sometimes fatal. As for our case, the patient was on a clinical decline majorly due to dysautonomia and nearing the end of life over the past year. A holistic approach of possible de-escalating care and palliative care might lead to a better quality of life for the patients and their families. Nevertheless, generally speaking, emergent presentations of dysautonomia symptoms in patients with PD should be recognized and treated timely and appropriately in the emergency room. Emergency clinicians need to increase awareness and make efforts to manage these acute worsening episodes of dysautonomia disorders in patients with PD to prevent debilitating and fatal complications.