Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 6350  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  » Next article
  » Previous article 
  » Table of Contents
  
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
  »  Article in PDF (73 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

 
  In this Article
 »  Abstract
 »  Introduction
 »  Case Report
 »  Discussion
 »  References

 Article Access Statistics
    Viewed5775    
    Printed111    
    Emailed4    
    PDF Downloaded111    
    Comments [Add]    
    Cited by others 4    

Recommend this journal

   
SHORT REPORTS
Year : 2004  |  Volume : 52  |  Issue : 3  |  Page : 390-391

An intramedullary tumor presenting with hyperhidrosis


Departments of Neurosurgery, AMRI Hospital, Kolkata, India

Date of Acceptance27-Sep-2002

Correspondence Address:
Park Neurosciences Service, Park Clinic, 4 Gorky Terrace, Calcutta - 700 017, India
sandipc1@vsnl.com

 » Abstract 

A case of a cervical intramedullary tumor is reported whose presentation was with disabling hyperhidrosis. The symptom resolved after surgical debulking of the tumor. Hyperhidrosis as a presenting manifestation of an intramedullary tumor has not been reported earlier.

How to cite this article:
Chatterjee S, Ghosh K, Banerjee T. An intramedullary tumor presenting with hyperhidrosis. Neurol India 2004;52:390-1


How to cite this URL:
Chatterjee S, Ghosh K, Banerjee T. An intramedullary tumor presenting with hyperhidrosis. Neurol India [serial online] 2004 [cited 2019 Nov 19];52:390-1. Available from: http://www.neurologyindia.com/text.asp?2004/52/3/390/12748



 » Introduction Top

We report an unusual case of hyperhidrosis in a middle-aged woman, as a presenting feature of an intramedullary cervical tumor. We could not locate any similar case in the literature.

 » Case Report Top

A 56-year-old lady presented with difficulty in using her hands as the initial complaint for a period of 6 months. This was followed by excessive sweating involving her head and neck area, so much so that she had to use 10-12 handkerchiefs daily to wipe herself. By the time she was seen at the Clinic, she had also started experiencing difficulty in walking "with a tendency to fall forwards" and had also developed urgency of micturition. However her main disabling symptom was hyperhidrosis.
On examination, she had a mild spastic quadriparesis. She was also observed to have wasting and weakness of the small muscles of her hands. There was excessive sweating in her face and head and neck area, without significantly increased sweating in her trunk or limbs. MR scan of her cervical spine showed a large intramedullary space-occupying lesion extending from the level of the foramen magnum down to the D2 level. A syrinx was identified both above and below the level of the lesion. She declined surgery initially only to return after 2 months with advanced neurological deficits. At this time she had marked spastic quadriparesis, disabling hyperhidrosis, urge incontinence, decreased sensation to pinprick below her sternal angle, and diminished posterior column sensations in her lower limbs. She could barely stand unaided, was dyspnoeic and had abdominal respiration without much excursion of her chest wall. The tumor was debulked after performing a C2 to D2 laminectomy.
Postoperatively the patient had dramatic and complete cessation of her hyperhidrosis. Her spastic quadriparesis gradually improved, and at the time of discharge she was able to walk unaided and was able to pass urine normally. She had no respiratory problem. A follow-up MR scan was done after 6 months and the T1 weighted Gadolinium enhanced image [Figure - 1] showed a small residual tumor. The histopathological examination confirmed that the tumor was an astrocytoma.

 » Discussion Top

Intramedullary spinal cord tumors can present with a variety of symptoms.[1] Neck or back pain is often the earliest symptom.[2] Sensory symptoms frequently antedate the motor symptoms and are consistent with the central location of the lesion within the spinal cord. Involvement of the descending autonomic pathways, which are located between the corticospinal and spinothalamic tracts may cause both sympathetic and parasympathetic disturbances below the level of the lesion.
Hyperhidrosis has been described in spinal cord injured patients,[3],[4] and also in post-traumatic syringomyelia.[5] A syndrome of autonomic dysreflexia has been described[6] which occurs in patients with lesions of the spinal cord above the D6 spinal level. This is characterized by exaggerated autonomic responses to stimuli which may be innocuous in normal individuals. In our patient it is likely that there was involvement of the sympathetic fibers in the upper cervical cord or in the ciliospinal center of Budge at the C8-D2 segmental level.
Hyperhidrosis in this instance may be postulated to have occurred as a result of overactivity of the sympathetic fibers due to irritation by the tumor. It may be hypothesized that had no treatment been done, the hyperhidrosis may have gradually progressed to anhydrosis. 

 » References Top

1.McCormick PC, Stein BM. Spinal cord tumours in adults. In: Youmans JR, editor Neurological Surgery. Philadelphia: WB Saunders 1996:3111-4.  Back to cited text no. 1    
2.Sloof JL, Kernohan JW, MacCarthy CS. Primary Intramedullary Tumours of the Spinal Cord and Filum terminale. Philadelphia: WB Saunders 1964.  Back to cited text no. 2    
3.Holzle E. Physiopathologic aspects and clinical pictures in hyperhidrosis. (article in German) Hautartz 1983;34:596-604.  Back to cited text no. 3    
4.Staas WE Jr, Nemunaitis G. Management of reflex sweating in spinal cord injured patients. Arch Phys Med Rehabil 1989;70:544-6.  Back to cited text no. 4    
5.Stanworth PA. The significance of hyperhidrosis in patients with post-traumatic syringomyelia. Paraplegia 1982;20:282-7.  Back to cited text no. 5    
6.Kewalramani LS. Autonomic dysreflexia in traumatic myelopathy. Am J Phys Med 1980;59:1-21.  Back to cited text no. 6    

 

Top
Print this article  Email this article
Previous article Next article
Online since 20th March '04
Published by Wolters Kluwer - Medknow