When should I consider referring a patient with suspected autonomic dysfunction to a specialist?

You should consider referring a patient with suspected autonomic dysfunction to a specialist in the following circumstances:

• Postural Hypotension: If blood pressure measurements do not confirm postural hypotension despite the patient experiencing suggestive symptoms, refer them for further specialist cardiovascular assessment ².
• Transient Loss of Consciousness (TLoC) in Older Adults: Consider referring anyone aged older than 65 years who has experienced TLoC without prodromal symptoms for cardiovascular assessment within 24 hours ².
• Suspected Cauda Equina Syndrome: Refer immediately, in line with local pathways, adults who have severe low back pain radiating into the leg and new-onset disturbance of bladder, bowel or sexual function, or new-onset perineal numbness, to have an assessment for cauda equina syndrome ¹.