Rousseaux M, Hurtevent J F, Benaim C, Cassim F
Service de Rééducation et Convalescence Neurologiques, Centre Hospitalier Universitaire, Lille, France.
Stroke. 1996 May;27(5):991-5. doi: 10.1161/01.str.27.5.991.
This study describes unilateral increases of sweating reactions observed in the months after contralateral medullary infarct; evaluation of sympathetic cutaneous response may help to explain sweating disorders.
After the discovery of the clinical phenomenon in one case, patients admitted between 1990 and 1993 were systematically evaluated clinically and electrophysiologically. In a group of five patients presenting with lateral or dorsal medullary lesions, two exhibited an increase of contralateral sweating reactions that appeared 6 to 8 months after stroke, were elicited by effort and exposure to heat and stress, and were more severe over the forehead, face, and upper trunk. In one case, this was clinically associated with an absence of sweating on the side of the lesion. During the late phase after stroke, in three patients presenting with lateral medullary lesions, electrophysiological evaluation revealed significant asymmetry of the sympathetic skin response, which was higher on the side contralateral to the lesion than on the ipsilateral side. In one patient, no response could be elicited by stimulations applied on the side of the lesion.
Contralateral hyperhidrosis can be observed in the late phase after lateral medullary infarct and is likely due to lesion of the sympathetic pathway passing through the lateral medulla, which inhibits sudomotor neurons. Evaluation of sympathetic skin response may help to explain such clinical disorders.
本研究描述了在对侧延髓梗死数月后观察到的单侧出汗反应增加；评估交感神经皮肤反应可能有助于解释出汗障碍。
在1例患者中发现这一临床现象后，对1990年至1993年间收治的患者进行了系统的临床和电生理评估。在一组5例表现为外侧或背侧延髓病变的患者中，2例出现对侧出汗反应增加，在中风后6至8个月出现，由用力、受热和应激诱发，在前额、面部和上躯干更为明显。在1例患者中，这在临床上与病变侧无汗相关。在中风后期，在3例表现为外侧延髓病变的患者中，电生理评估显示交感神经皮肤反应存在明显不对称，病变对侧高于同侧。在1例患者中，对病变侧进行刺激未引出反应。
在外侧延髓梗死后期可观察到对侧多汗，可能是由于穿过外侧延髓的交感神经通路受损，抑制了汗腺运动神经元。评估交感神经皮肤反应可能有助于解释此类临床疾病。
