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Autonomic Neuropathy – Ewing Battery — SCE Neurology MCQ

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HardClinical NeurophysiologyAutonomic Neuropathy – Ewing BatterySCE Neurology

A 58-year-old with diabetes undergoes an age-adjusted Ewing battery. Heart-rate responses to deep breathing and the Valsalva manoeuvre are abnormal; the 30:15 ratio, orthostatic systolic-pressure response and sustained-handgrip response are normal. What is the best interpretation?

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Correct answer: A — The battery supports definite dysautonomia because at least 2 of 5 standard tests are abnormal

The Ewing battery combines five non-invasive cardiovascular reflex tests: three predominantly cardiovagal heart-rate measures and two sympathetic blood-pressure responses. The conventional composite criterion classifies dysautonomia when at least 2 of the 5 tests are abnormal, particularly when age-adjusted reference values are applied. Two abnormal cardiovagal tests therefore support dysautonomia even though the adrenergic components are preserved. Normal orthostatic pressure does not exclude earlier parasympathetic involvement, and neither skin biopsy nor sudomotor testing is required to interpret the cardiovascular battery itself.

Reference: Cutoffs, sensitivity and specificity of the Ewing battery in evaluating autonomic nervous system disorders: https://link.springer.com/article/10.1007/s10286-025-01185-x