Hyperhidrosis as a reflection of autonomic failure in patients with acute hemispheral brain infarction. An evaporimetric study.

Abstract

Background and Purpose: Sweating dysfunction is one of the most frequently encountered symptoms of autonomic failure but has received scant attention in patients with cerebrovascular diseases. Our purpose was to evaluate the prevalence, pathogenesis, and clinical correlates of sweating dysfunction in stroke.Methods: We studied sweating at baseline and after a heating stimulus in 53 patients with acute hemispheral brain infarction and in 40 healthy control subjects by using a quantitative evaporimetric method.Results: Significant hyperhidrosis on the paretic side of the body was verified in 55% of the patients at baseline, in 74% after 5 minutes of heating, and in 77% after 10 minutes of heating. Hyperhidrosis was established throughout the body and correlated with the severity of paresis, the presence of reduced muscle tone, and the extensor plantar response.Conclusions: The phenomenon of hyperhidrosis in hemiparetic patients reflecting autonomic dysfunction seems to be a common manifestation that should be listed among the expected consequences of brain infarction. This sweating disturbance might be attributed to a lesion of a putative sympathoinhibitory pathway controlling sweating. The failure of this pathway could also be related to other manifestations of sympathetic hyperfunction, e.g., cardiac complications. Therefore, assessment of sweating may provide a new, important aspect in the evaluation of stroke patients. (Stroke 1992;23:1271-1275 KEY WORDS • autonomic dysfunction • cerebral infarction • sweating

Localization of the Brain Lesion Affects the Lateralization of T‐Lymphocyte Dependent Cutaneous Inflammation. Evidence for an Immunoregulatory Role of the Right Frontal Cortex–Putamen Region

“…Indeed, we have recently demonstrated that the lateralization of DTH responses was significantly correlated to alteration of sympathetic nerve traffic in early stroke [21]. In addition, Korpelainen et al [29] and Naver et al [30] recently demonstrated that acute hemispheral brain infarction leads to lateralization of sympathetic nerve traffic.…”

“…In addition, Korpelainen et al . [29] and Naver et al . [30] recently demonstrated that acute hemispheral brain infarction leads to lateralization of sympathetic nerve traffic.…”

Autonomic nervous system disorders in stroke

“…In most of these studies, however, only nonquantitative methods for assessing the amount of sweating have been used. By using quantitative evaporimetric measurements, our group [65,66] established an asymmetric sweating pattern in the majority of hemispheric stroke patients (Fig. 2).…”

“…The phenomenon is probably caused by an interruption of the cortica] sympathoinhibitory input to the putative neural pathway that controls sweating on the contra]ateral side of the body [49,[64][65][66]. Although the course of the sympathetic sudomotor pathway descending from the hypothalamus is clear, little is known about the higher neural structures regulating sweating.…”

Sudation et hyperhidrose (sécrétion accrue de sueur)

“…Une sudation gustative est constatée cependant aussi en pré-sence de neuropathie diabétique (compensatoire), de blessures des Corda tympani, après des infections par Herpes Zoster, dans les cé-phalées de cluster (Cluster-Headache) après «Neck-dissection» et excision des glandes submandibulaires. L'infarctus cérébral conduit à une hyperhidrose significative sur le côté parésique du corps [7]. Une maladie neurologique avec hyperhidrose généralisée est le syndrome de Rilay-Day ou la dysautonomie familiale.…”