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Hyperhidosis in Acute Ischemic Stroke
E Prasanna Venkatesan1, N Balamurugan2
1 Department of Neurology, Appusami Hospital, Salem, Tamil Nadu, India
2 Sim's Chellum Hospital, Salem, Tamil Nadu, India
E Prasanna Venkatesan,
Appusami Hospital, Salem, Tamil Nadu
Source of Support: None, Conflict of Interest: None
A 45-year-old male with untreated diabetes and hypertension presented to our emergency department with an acute onset of left hemiparesis. On arrival, his vital signs were stable and ECG (electrocardiogram) showed normal sinus rhythm. His CT (computed tomography) of the head showed right MCA infarct involving the insular cortex. Since the patient was out of the window for thrombolysis, he was given aspirin after ruling out intracranial haemorrhage [Figure 1]. He was shifted to the ICU for further management. On physical examination, he was found to have left hemiparesis with left facial droop. The most striking feature noted on general examination was profuse sweating on the hemiparetic side especially the face, chest, and arm. Multiple large drops of sweat were noted dripping continuously from the left half of the face, despite the patient lying below the air conditioner in the ICU [Figure 2]. The left side was cooler compared to the right side. Initially, we suspected anhidrosis of the right side; however, there was neither ptosis nor miosis to support right-sided Horner's syndrome. We also did a carotid duplex which ruled out right carotid dissection.
|Figure 2: Plain CT head showing acute infarction right MCA territory involving insula and operculum|
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Contralateral hyperhidrosis (excessive sweating) following acute ischemic stroke has been reported previously due to many lesions of the cerebral hemisphere. Large MCA territory infarction, smaller infarctions involving operculum, pons, medulla, and spinal cord have all resulted in unilateral hyperhidrosis in the literature., Labar et al. observed hyperhidrosis in only 6 out of 633 consecutive stroke patients. Based on this study, the incidence of contralateral hyperhidrosis in stroke is about 1–2%. The sweating is variable and can last from 2 days to 2 months. Korpelainen et al. did a prospective study of sweating in patients with ischemic stroke. Significant asymmetry in sweating occurred in 73% of the patients in the acute phase of infarction. They also found that hyperhidrosis is correlated with the severity of paresis and the presence of pyramidal tract signs. Korpelainen et al. also studied asymmetric skin temperature in acute ischemic stroke and found a consistent decline in temperature on the limbs contralateral to the site of infarction because of possible autonomic failure.
The exact pathophysiological mechanisms of unilateral hyperhidrosis associated with acute ischemic stroke are unknown. It was hypothesized that the inhibitory neural pathway that controls sweating of the contralateral side might originate in the opercular cortex, projecting into the hypothalamus and brainstem. It crosses in the medulla and makes terminal connections with the contralateral thoracic spinal cord.
In conclusion, contralateral hyperhidrosis following acute stroke is a very rare clinical sign. Contralateral hyperhidrosis is usually self-limiting and does not warrant any additional workup. The clinical significance of it is currently unknown.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| » References|| |
Korpelainen JT, Sotaniemi KA, Myllyla VV. Asymmetric sweating in stroke: A prospective quantitative study of patients with hemispheral brain infarction. Neurology 1993;43:1211-4.
Appenzeller O. Sweat gland activity and disturbances of sweating. In: Appenzeller O, editor. The Autonomic Nervous System. 4th
ed. New York, NY: Elsevier Science Publishing Co, Inc; 1990. p. 117-40.
Labar DR, Mohr JP, Nichols FT, Tatemichi TK. Unilateral hyperhidrosis after cerebral infarction. Neurology 1988;38:1679-82.
Kim BS, Kim YI, Lee KS. Contralateral hyperhidrosis after cerebral infarction. Clinicoanatomic correlations in five cases. Stroke 1995;26:896-9.
[Figure 1], [Figure 2]