What're the symptoms of Shy-Drager syndrome?
Symptoms of autonomic failure such as constipation, impotence in men, and urinary incontinence usually predominate early in the course of the disease. Constipation may be unrelenting. Other symptoms that may develop later include impaired speech, difficulties with breathing and swallowing, and inability to sweat (anhidrosis). extrapyramidal symptoms
or cerebellar symptoms may predominate early in the course. There may be tremors and rigidity reminiscent of Parkinson disease. Loud snoring is common, as is sleep apnea. Shy-Drager syndrome usually ends in death within 15 years of the diagnosis. Breathing problems such as aspiration, stridor (high-pitched breathing sounds due to airway obstruction), or cardiopulmonary arrest are the common causes of death.
Patients with Shy-Drager syndrome usually have problems with the function of the autonomic nervous system. Progressive degeneration may occur in other areas of the nervous system as well. The hallmark of the syndrome is dizziness and fainting when arising or after standing still for a long time (postural hypotension). This is caused by low blood pressure and inadequate blood flow to the brain. When this problem becomes severe (for example, a blood pressure below 70/40 mmHg), it can lead to a momentary loss of consciousness. When the person faints, the blood pressure returns to normal and the persons wakes up.
Many patients also notice impotence, urinary incontinence, dry mouth and skin, and trouble regulating body temperature because of abnormal sweating. Since the autonomic nervous system also controls the narrowing and widening of the iris, some patients with SDS have vision problems, such as trouble focusing. In later stages, problems in the autonomic nervous system lead to breathing difficulties such as sleep apnea, loud breathing, and snoring. In advanced stages of the disease, patients can die from irregular heartbeat.
Other symptoms of Shy-Drager syndrome do not involve the autonomic nervous system. These include parkinsonism (muscle tremor, rigidity, and slow movements), double vision, problems controlling emotions, and wasting of muscles in the hands and feet. Eventually, patients may have problems chewing, swallowing, speaking, and breathing. There may be a loss of color pigment in the iris.