[Treatment of hyperhidrosis with caudal epidural alcohol block in a patient with cervical cord injury].

A 44-year-old man complained of intermittent and excessive sweating of head and neck throughout the day, followed by severe lower abdominal spasms. He had been suffering from complete paraplegia with neurogenic bladder for 16 years, due to C7 spinal cord injury. In the last 16 years he had four episodes of hyperhidrosis, and these were treated by subarachnoid phenol block. The patient was referred to our clinic this time because of the dry tap during attempted subarachnoid phenol block. We tried several test blocks, lumbar epidural block, inferior mesenteric plexus block, celiac plexus block and caudal epidural block in order to clarify the afferent route of this reflex, because as a cause of this reflex sweating, no physical abnormality was detected. With caudal epidural block abnormal sweating disappeared completely. This finding led us to conclude that the somatic sacral nerves from bladder were afferent routes. We injected 20 ml of 75% alcohol into the caudal epidural space to destroy sacral nerves 5 times in 4 weeks. In a follow up examination, 5 months after his discharge, except minimal complaints about mild lower abdominal spasms, there were no complications from alcohol injection.