Asymmetric sweating in a child with multiple sclerosis

Ueno, Masashi; Tokunaga, Yoichi; Terachi, Shinichi; Gondo, Kenjiro; Hara, Toshiro

doi:10.1016/s0887-8994(00)00155-7

Cited by 21 publications

(22 citation statements)

References 10 publications

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“…Thermography has shown significant thermal asymmetry in the patient, with central neurogenic pattern, by involving right hemibody (face, trunk and extremities). Similar case was reported in a study 14 with a child with MS, who presented excessive sweating on right face and shoulder. Unilateral hyperhydrosis of the whole hemibody is a central neurovegetative phenomenon which, comparatively, is similar to skin vasomotor change found in this patient.…”

Section: Discussionsupporting

confidence: 85%

“…Knowing this, it is possible to notice the usefulness of the study of thermoregulation in this population since the onset of the disease 13 . Ueno et al 14 have performed thermography in a child diagnosed with MS and complaining of unilateral sweating. Another study from the 1960s has shown asymmetric temperature pattern in MS patients 15 , however this was only evaluated in the face and diagnostic impressions are not clearly described, making difficult the comparison with current studies.…”

Section: Introductionmentioning

confidence: 99%

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Infrared thermography to evaluate pain in a multiple sclerosis patient. Case report

2016

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BACKGROUND AND OBJECTIVES:Multiple sclerosis is an autoimmune, inflammatory, demyelinating and chronic disease of the central nervous system. As from the understanding of its pathophysiology and of thermoregulating dysfunctions caused by the disease, it is clear that, whenever possible, infrared thermography should be done. Thermography helps understanding how the disease affects different body areas, by investigating asymmetries, contractures and neurogenic patterns. This study aimed at documenting by infrared thermography a case of multiple sclerosis in crisis of pain. CASE REPORT: Female patient, 63 years old, diagnosed with multiple sclerosis in 2007 after magnetic resonance and lumbar puncture. Six month ago she started complaining of progressive decrease in lower limbs muscle strength in addition to increased spinal pain, especially in lumbar spine and right hemibody. Patient was submitted to new exams (head and cervical spine resonance), which have shown the same pattern found in previous exams, resulting from old injuries by demyelinating substract. Thermometry has shown asymmetry of the whole right hemiboby with central neurogenic patterns and temperature difference (∆T 0.8ºC), thus confirming initial diagnosis. With regard to major complaint, there was asymmetry between paralumbar regions and presence of lumbar paravertebral hyperradiation, suggesting local muscles contracture. CONCLUSION: Multiple sclerosis has a wide range of symptoms, especially the installation of chronic pain and inadequate thermoregulation, which directly interfere with quality of life of patients.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Infrared thermography to evaluate pain in a multiple sclerosis patient. Case report

2016

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“…Anhidrosis, which originated primarily on the left side, would be caused by direct injury of descending sympathetic fibres in the hypothalamic lesion deviating to the left. Similar to our patient, a unilateral hypothalamic lesion in a child with multiple sclerosis was reported by Dr. Ueno et al [6] to cause an asymmetric sweating. This patient had a left unilateral hypothalamic lesion on MRI and suffered from hyperhidrosis on his right (contralateral) side.…”

Section: Dear Sirssupporting

confidence: 91%

Anhidrosis associated with hypothalamic lesions related to anti-aquaporin 4 autoantibody

et al. 2011

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Serum anti-aquaporin 4 (AQP4) antibody is detected with high specificity in patients with neuromyelitis optica (NMO), characterised by recurrent optic neuritis and longitudinally extensive transverse myelitis [1,2]. Three NMO patients with anti-AQP4 antibody were reported to have hypothalamic lesions, showing reduced hypocretin-1 levels in cerebrospinal fluid (CSF) and symptomatic narcolepsy [3]. Although the hypothalamus and hypocretin-1 regulate autonomic functions as well as sleep, autonomic functions in NMO patients with hypothalamic lesions have not been described well. Here we report the case of a patient with anhidrosis and narcolepsy as initial symptoms of disorders related to anti-AQP4 antibody.A 41-year-old woman was experiencing excessive daytime sleepiness. Cataplexy was not evident. One month after, she became aware of anhidrosis on the left side of her body including the face. The following month, she was admitted to our hospital because of hypersomnia and anhidrosis that extended throughout her entire body.Physical and neurological examination revealed hypotension (93/62 mmHg) and dry skin. Brain magnetic resonance imaging (MRI) showed a high signal intensity area around the third ventricle on fluid-attenuated inversionrecovery image (Fig. 1a). Multiple sleep latency test showed shortening of the mean sleep latency (4.8 min; normal: [8 min) and sleep-onset REM periods. Lumbar puncture showed only a decrease of CSF hypocretin-1 levels (177 pg/ml, normal:[200 pg/ml). Serum anti-AQP4 antibody was positive. Although sympathetic skin responses (SSR) were absent in all limbs (Fig. 1c), intracutaneous acetylcholine injection caused normal sweating reaction.The patient was diagnosed with NMO spectrum disorders having narcolepsy and anhidrosis, secondary to hypothalamic lesions associated with anti-AQP4 antibody, and treated with intravenous methylprednisolone (1 g/day) for 3 days, followed by oral prednisolone (1 mg/kg/day). After treatment, her excessive sleepiness and anhidrosis disappeared in a few days. MRI showed improvement of the abnormal intensity area (Fig. 1b), and CSF hypocretin-1 levels had recovered to 213 pg/ml. Moreover, repeated tests of SSR showed positive responses (Fig. 1d).Anhidrosis of the entire body was detected and confirmed by SSR in our patient associated with anti-AQP4 antibody as well as symptomatic narcolepsy. After treatment, the reduced CSF hypocretin-1 levels returned to normal in parallel with improvement of excessive daytime sleepiness, similar to previously reported NMO cases [3]. The hypothalamus is the highest level of integration of autonomic function; tumors, trauma, inflammation, or vascular disorders in this structure are known to cause autonomic dysfunctions such as hypothermia or abnormal

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“…Demyelinating lesions located among central thermoregulatory pathways may result in regional or global anhidrosis in patients with MS. The risk is greater with increased plaque burden [44,55]. The majority of patients presented with subclinical dysfunction of the sudomotor system, indicated by an abnormal sympathetic skin response (Fig.…”

Section: Sudomotor Dysfunctionmentioning

confidence: 99%

Autonomic dysfunction in multiple sclerosis

2006

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Multiple sclerosis (MS) is the most frequent chronic neurological disease affecting young persons in developed countries. MS is, however, considered as a secondary cause, of central origin, for autonomic dysfunction. The most common autonomic symptoms in MS are disorders of micturation, impotence, sudomotor and gastrointestinal disturbances, orthostatic intolerance as well as sleep disorders. The majority of the patients suffer at some period of the disease from lower urinary tract symptoms and sexual dysfunction. Awareness and treatment of these conditions is vital to improving health and quality of life in patients with MS. The increased understanding of the pathophysiological mechanisms in autonomic dysfunction in MS, along with technological and pharmaceutical developments has advanced our ability to treat the multiple aspects complicating autonomic failure in MS.

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Asymmetric sweating in a child with multiple sclerosis

Cited by 21 publications

References 10 publications

Infrared thermography to evaluate pain in a multiple sclerosis patient. Case report

Infrared thermography to evaluate pain in a multiple sclerosis patient. Case report

Anhidrosis associated with hypothalamic lesions related to anti-aquaporin 4 autoantibody

Autonomic dysfunction in multiple sclerosis

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