Anhidrosis: a clue to an underlying autonomic disorder.
We describe a patient with Ross syndrome who had the classic triad of segmental anhidrosis, tonic pupils and hyporeflexia. Dilute pilocarpine (0.1%) instillation in both eyes revealed parasympathetic denervation hypersensitivity. There was evidence of cardiac dysautonomia in the form of a decrease in heart rate variability with deep breathing and an abnormal Valsalva response. A thermoregulatory sweat test showed the presence of sweating in the right cheek, neck and upper one-third of the left arm and shoulder only. Sympathetic skin responses were absent in the affected segments of the upper limb. Ross syndrome is a degenerative disorder that progressively involves different fibre populations, starting with autonomic fibres and then involving the unmyelinated and myelinated sensory fibres. A careful clinical examination and simple bedside autonomic tests can confirm the diagnosis.
Chemmanam
Thomas
T
Department of Neurology, Christian Medical College, Ludhiana, Punjab, India.
Pandian
Jeyaraj D
JD
Kadyan
Randhir S
RS
Bhatti
S M
SM
D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000150:complications* / Q000175:diagnosis; D001794:Blood Pressure / Q000187:drug effects; D006801:Humans; D007007:Hypohidrosis / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008916:Miotics; D009431:Neural Conduction; D010862:Pilocarpine; D011680:Pupil / Q000502:physiology; D012021:Reflex, Abnormal / Q000502:physiology; D013577:Syndrome
D008916:Miotics; D010862:Pilocarpine