What are the symptoms of autonomic instability in rabies?

Updated: Jun 21, 2019
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Autonomic instability is observed with furious rabies, with symptoms that include the following:

  • Fever

  • Tachycardia

  • Hypertension

  • Hyperventilation

  • Anisocoria, fixed pupillary dilation (“blown pupil”), optic neuritis (may falsely suggest brain death)

  • Facial palsy

  • Mydriasis

  • Lacrimation

  • Excessive salivation

  • Perspiration

  • Postural hypotension

In patients with paralytic rabies, fever and nuchal rigidity may occur. Paralysis is symmetrical and may be either generalized or ascending and may be mistaken for Guillain-Barré syndrome. The sensory system is usually spared. Calm clarity gradually progresses to delirium, stupor, and then coma.

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