Since Young et al 1described a patient with acute loss of sympathetic and parasympathetic functions in 1969, many similar cases have been reported as being acute idiopathic autonomic neuropathy.2 Apart from acute cholinergic neuropathy, there are four types of acute idiopathic autonomic neuropathy, classified according to somatic nerve involvement: acute pandysautonomia, which has minimal or no motor or sensory dysfunctions3;acute autonomic and sensory neuropathy in which sensation is seriously involved4-6; Guillain-Barré syndrome with prominent dysautonomia, manifesting autonomic and somatic motor dysfunctions; and acute autonomic sensory and motor neuropathy, characterised by prominent dysautonomia and severe motor and sensory impairment. Despite minimal or no sensory disturbance, reduction of myelinated fibres in biopsied sural nerve has been found in several cases with acute pandysautonomia.3However, the exact site of pathological involvement in the sensory system remains unknown, because postmortem examinations have seldom been performed. We report a case of acute pandysautonomia with no evidence of significant somatic nerve involvement, accompanied by dorsal root ganglionopathy shown by postmortem examinations.

An 18 year old male student experienced low grade fever, vomiting, and tingling pain in the limbs on 26 February 1987. Orthostatic syncopy occurred three times on the next day. Difficulty in emptying the bladder, alternate diarrhoea and constipation, and lack of sweating over the whole body developed rapidly. He was admitted to the Third Department of Internal Medicine, Medical College of Oita on 24 April 1987. On physical examination, he weighed 46 kg, with a recent weight loss of 14 kg. Blood pressure was 108/78 mm Hg in the supine position and heart rate was 88/min. When changing from the supine to theupright position, he …