Local autonomic failure affecting a limb.

Three patients are described who presented with autonomic failure affecting predominantly one limb. Physiological studies revealed that there was sweating loss in the limb which appeared to be due to a preganglionic autonomic lesion and not to a sweat gland abnormality. In all three patients there was also evidence of failure of vasomotor control. There was no evidence of more generalised autonomic failure or neurological deficit. In two patients the condition appeared to be static and, according to the patients' accounts was life long. In the third the sweating loss was present for three years prior to pain loss becoming evident from C2/3 to T1 on the same side as the sweating loss. These patients, together with two recent case reports, indicate that isolated local autonomic failure, probably from a discrete cord lesion, can be a cause of presenting symptoms related to sweating loss or to change in temperature in a limb.