Cumulative Autonomic Injury and Secondary Multifactorial Dysautonomia: A Lived Case Integrated with a Central Autonomic Regulatory Model
Abstract
Bruce H. Knox
Background: Dysautonomia arising from cumulative physiological insult remains poorly characterised, particularly when involving both chronic post-viral injury and acute cardiovascular trauma.
Objective: To integrate a lived patient narrative with a physiologically grounded model of central autonomic dysregulation and long-term recovery.
Methods: A longitudinal first-person clinical narrative is combined with a structured three-layer autonomic model and supported by current literature in autonomic neuroscience and cardiovascular physiology.
Results: The clinical presentation is best explained by central autonomic dysregulation with impaired gain control rather than structural autonomic failure. A three-hit framework—post-viral priming, cardiac tamponade, and surgical insult—accounts for both collapse and delayed recovery.
Conclusion: This case demonstrates that complex dysautonomia may represent regulatory instability following cumulative injury. Recovery occurs through delayed neuroplastic adaptation, resulting in stabilisation with persistent limitations rather than full restoration.