A case of traumatic high thoracic myelopathy presenting dissociated impairment of rostral sympathetic innervations and isolated segmental sweating on otherwise anhidrotic trunk.
A 3 year-old boy developed flaccid paraplegia, anesthesia below T3 and impaired vesical control immediately after a car accident. Three months later, the pupils and their pharmacological reactions were normal. Thermal sweating was markedly reduced on the right side of the face, neck, and shoulder and on the bilateral upper limbs, and was absent below T3 except for band like faint sweating on T7 sensory dermatome. The left side of the face, neck and shoulder showed compensatory hyperhidrosis. Facial skin temperature was higher on the sweating left side. Cervico-thoracic MRI suggested almost complete transection of the cord at the levels of T2 and T3 segments. We discussed the pathophysiology of the dissociated impairment of rostral sympathetic innervations and isolated segmental sweating on otherwise anhidrotic trunk.
Saito
H
H
Department of Neurology, Nishitaga National Hospital, Sendai, Japan. hsaito@nisitaga.hosp.go.jp
Sakuma
H
H
Seno
K
K
D000063:Accidents, Traffic; D001284:Atrophy; D002675:Child, Preschool; D005145:Face; D007839:Functional Laterality; D006358:Hot Temperature; D006801:Humans; D006945:Hyperhidrosis / Q000209:etiology*; D007007:Hypohidrosis / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D009333:Neck; D010264:Paraplegia / Q000209:etiology*; D012881:Skin Temperature; D013118:Spinal Cord Diseases / Q000209:etiology*; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016103:Spinal Fractures / Q000175:diagnosis*; D013546:Sweating; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D013904:Thoracic Vertebrae