1/174. A case of reflex sympathetic dystrophy (complex regional pain syndrome, type I) resolved by cerebral contusion. We present a case of refractory reflex sympathetic dystrophy (RSD) (complex regional pain syndrome, type I) whose symptoms (ongoing pain, allodynia, hyperhydrosis and temperature abnormalities) were resolved after the patient suffered a traumatic cerebral contusion in the left temporal lobe, which caused no neurological deficit. This case suggests that symptoms of some RSD patients may largely sustained by a complex network involving the brain. ( info) |
| The use of an aqueous solution of 0.5% topical glycopyrollate was effective in the treatment of hyperhidrosis of the scalp and forehead after other treatments had proved ineffective; this appears to be the first report of its use in this condition. ( info) |
3/174. A functioning eccrine hamartoma associated with Down's syndrome (46, xx,-21, t(21q21q). Pure eccrine hamartomas are very rare, and commonly present as localized areas of hyperhidrosis in normal looking skin. We describe a case of bilateral functioning eccrine hamartomas with macroscopically abnormal features in association with Down's syndrome. ( info) |
4/174. Acute varicella zoster with postherpetic hyperhidrosis as the initial presentation of hiv infection. A 31-year-old man presented with acute pain in his left arm and hemorrhagic vesicles that followed his left 8th cervical nerve. A diagnosis of herpes zoster was made, and the patient was treated with valacyclovir. He refused testing for antibodies to hiv because he denied being at risk. Two months later he returned with postherpetic neuralgia and postherpetic hyperhidrosis in the distribution of the vesicles, which had since resolved. serology for hiv at this visit was positive, and the patient admitted to having sexual relations with prostitutes. Six months later the patient was being treated with triple antiretroviral therapy, and all signs and symptoms of postherpetic zoster had resolved. This case report documents the need for hiv testing in patients with unusual presentations of herpes zoster even if they initially deny being at risk. ( info) |
5/174. 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. ( info) |
6/174. Extensor pollicis longus paralysis following thoracoscopic sympathectomy. Thoracoscopic sympathectomy is an acceptable form of treatment for palmar hyperhidrosis. Many authors have reported favourable results. Complications range from pneumo-haemothorax, Horner's syndrome, compensatory hyperhidrosis and bleeding. Plas et al reported 2.7% of the procedures had complications requiring intervention and 9.7% had non-interventive complications. There have been isolated reports of other rare complications including false aneurysm of intercostal artery, inferior brachial plexus injury and abnormal suntanning. We report an unusual case of isolated extensor pollicis longus paralysis after a thoracoscopic sympathectomy for palmar hyperhidrosis, in a fit young male. Such complications have not been previously reported. We recognise that such isolated nerve injury is uncommon. ( info) |
7/174. Remission of facial and scalp hyperhidrosis with clonidine hydrochloride and topical aluminum chloride. Axillary and palmar hyperhidrosis are featured prominently in the literature, but no previous studies have detailed a treatment regimen for specific excessive localized sweating of the face and scalp. In this report, a patient was treated for this condition with a combination of clonidine hydrochloride (0.3 mg to 0.4 mg, with 0.25 mg to be taken at bedtime, to prevent daytime sedation) [corrected] and a topical solution of 20% aluminum chloride in anhydrous ethyl alcohol (Drysol). Over a period of 2 or 3 weeks, the patient achieved a complete remission of symptoms, while having only mild side effects. The treatment regimen also had the added advantage of lowering generalized anxiety. ( info) |
8/174. Idiopathic localized unilateral hyperhidrosis in a child. Idiopathic unilateral circumscribed hyperhidrosis is an extremely rare form of increased sweat production that occurs within a sharply demarcated area on the face or upper extremities of otherwise healthy patients. There are no associated neurovascular or metabolic abnormalities. We report idiopathic localized unilateral hyperhidrosis on the upper extremity of a healthy 4-year-old girl. ( info) |
9/174. Alternating monomeric paresis with decreased skin temperature and hyperhidrosis in a case of thoracolumbar myelopathy. The patient, a Japanese girl with a history suggestive of diffuse encephalitis or acute disseminated encephalomyelitis, developed weakness of the right lower limb accompanied by excessive sweating and decreased skin temperature. magnetic resonance imaging of the thoracolumbar cord showed abnormal signal intensity with syrinx formation mainly at T12 to L1 vertebral level. paresis and excessive sweating subsided within 3 to 4 months, but recovery of vasomotor function was delayed. Several weeks later, weakness and skin temperature reduction reappeared on the left side without hyperhidrosis, but responded well to oral prednisolone. The patient showed no recurrence during the subsequent 7 years, and the intramedullary lesion could not be seen with repeated spinal magnetic resonance imaging. ( info) |
10/174. Transient reactive papulotranslucent acrokeratoderma associated with cystic fibrosis. A 20-year-old female with cystic fibrosis presented with a white marginal palmar eruption after exposure to water. There was no family history of keratoderma. A biopsy showed hyperkeratosis around dilated eccrine ostia. These features are similar to a recently described condition, transient reactive papulotranslucent acrokeratoderma. This is thought to be a variant of hereditary papulotranslucent acrokeratoderma, one of the punctate keratodermas. association with cystic fibrosis has not been described previously. ( info) |