Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
World Neurosurg. 2019 Jul;127:232-236. doi: 10.1016/j.wneu.2019.03.115. Epub 2019 Mar 20.
Hyperhidrosis is caused by sympathetic dysfunction of the central or peripheral nervous system. However, intramedullary spinal cord tumors presenting with hyperhidrosis as an initial symptom have been rarely reported in the literature.
This case involves an 18-year-old man who presented with abnormal enhanced sweating and flushing on the bilateral side of his face and neck that had persisted for 6 years. Magnetic resonance (MR) images revealed that at the C7-T2 levels of the spinal cord, a large intramedullary tumor was involved in the cervicothoracic region. The patient underwent gross total resection of the tumor via the fluorescein-guided technique and intraoperative neurophysiologic monitoring. The histopathologic diagnosis revealed ganglioglioma. The symptoms gradually improved after surgery, and the patient presented with virtually complete remission at the end of an 18-month follow-up.
Few cases of intramedullary spinal cord tumors presenting as hyperhidrosis in clinical manifestation have been reported in the literature. Sympathetic irritation by the tumor, particularly in the location around the gray matter of the lateral spinal cord, may account for the hyperhidrosis as the initial symptom in this patient. Therefore, if a patient has autonomic dysfunction, the spine cord should be additionally examined using MR imaging.
多汗症是由中枢或外周神经系统的交感神经功能障碍引起的。然而，文献中很少有报道脊髓髓内肿瘤以多汗症为首发症状。
本例为 18 岁男性，表现为双侧面部和颈部异常性多汗和潮红，持续 6 年。磁共振成像（MR）显示颈胸段脊髓 C7-T2 水平存在累及颈胸段的大型髓内肿瘤。患者采用荧光素引导技术和术中神经生理监测行肿瘤大体全切除。组织病理学诊断为神经节细胞瘤。术后症状逐渐改善，18 个月随访结束时患者几乎完全缓解。
文献中报道的以多汗症为首发临床表现的脊髓髓内肿瘤病例较少。肿瘤对交感神经的刺激，特别是在脊髓外侧灰质周围的位置，可能是导致本例患者以多汗症为首发症状的原因。因此，如果患者存在自主神经功能障碍，应使用磁共振成像（MRI）对脊柱进行额外检查。
