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Suzuki M, Watari T. Idiopathic segmental anhidrosis in an older patient presenting with recurrent dizziness. BMJ Case Rep 2024; 17:e258324. [PMID: 38232995 PMCID: PMC10806922 DOI: 10.1136/bcr-2023-258324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Dizziness is one of the most common complaints encountered in the outpatient clinic, which is difficult to diagnose, especially in older patients because of the multifactorial nature of the disease. Although not commonly recognised, anhidrosis can also cause dizziness.We report a case of a woman in her 70s who presented with long-term recurrent dizziness. She had a history of frequent hospitalisations for heatstroke. Physical examination revealed markedly less sweating in the left axilla and soles than in the right. Minol test revealed that most of the left side of her body, including the face, was anhidrotic. She was diagnosed with idiopathic segmental anhidrosis. We administered steroid pulse therapy without observing any significant effects.Although anhidrosis is a rare disorder, a careful interview and physical examination should be conducted to confirm a history of heatstroke and the absence of sweating to avoid missing the disease.
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Affiliation(s)
- Morika Suzuki
- Department of General Internal Medicine, National Hospital Organisation Sendai Medical Center, Sendai, Miyagi, Japan
| | - Takashi Watari
- Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- General Medicine Center, Shimane University Hospital, Izumo, Shimane, Japan
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Mourad F, Giudice A, Maritati G, Maselli F, Kranenburg R, Taylor A, Kerry R, Hutting N. A guide to identify cervical autonomic dysfunctions (and associated conditions) in patients with musculoskeletal disorders in physical therapy practice. Braz J Phys Ther 2023; 27:100495. [PMID: 37075598 DOI: 10.1016/j.bjpt.2023.100495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 09/24/2022] [Accepted: 03/06/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Differential diagnosis is a hot topic in physical therapy, especially for those working in a direct access setting dealing with neck pain and its associated disorders. All international guidelines agree in recommending to first rule out non-musculoskeletal pathologies as the cause of signs and symptoms in the patient. Although the autonomic nervous system (ANS) has a crucial role and is also involved in pain conditions, coverage of it in neuroscience textbooks and educational programmes is limited and most healthcare professionals are unfamiliar with it. Although autonomic conditions are benign in nature, they are clinically of great importance as they may be a 'red flag' warning of an injury along the sympathetic pathway. Therefore, sound knowledge of the ANS system is essential for clinicians. OBJECTIVE To develop physical therapists' knowledge of and confidence in understanding cervical ANS function and dysfunction, thus enhancing clinical reasoning skills and the pattern recognition process, and performing and interpreting objective examinations. METHODS This master class provides an introductory guide and essential knowledge to facilitate clinicians to understand cervical autonomic dysfunctions and their clinical evaluation. The optimal referral method is also handled. CONCLUSIONS Gaining knowledge and understanding of the ANS, its function, its dysfunction, and the related clinical manifestations is likely to lead to a decision-making process driven by 'science and conscience'. This will empower physical therapists to be aware of subtle clues that may be offered by patients during the interview and history intake leading to the appropriate physical examination and triage.
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Affiliation(s)
- Firas Mourad
- Department of Physical Therapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg; Luxembourg Health & Sport Sciences Research Institute A.s.b.l., Differdange, Luxembourg
| | - Andrea Giudice
- Department of Physical Therapy, Poliambulatorio Physio Power, Brescia, Italy
| | - Giorgio Maritati
- Department of Physical Therapy, Poliambulatorio Physio Power, Brescia, Italy
| | - Filippo Maselli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; Sovrintendenza Sanitaria Regionale Puglia INAIL, Bari, Italy
| | - Rik Kranenburg
- Healthy Ageing, Allied Health Care and Nursing Research Group, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Alan Taylor
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, UK
| | - Roger Kerry
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, UK
| | - Nathan Hutting
- Department of Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, Nijmegen, the Netherlands.
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Singh GK, Arora S, Bahuguna A, Das P, Bellad P. Ross Syndrome Presenting as Heat Exhaustion: A Report of Two Cases. Indian J Occup Environ Med 2022; 26:198-200. [PMID: 36408429 PMCID: PMC9674069 DOI: 10.4103/ijoem.ijoem_107_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/11/2021] [Accepted: 10/02/2021] [Indexed: 01/25/2023] Open
Abstract
Ross syndrome is a rare clinical disorder of sweating associated with tonic pupil and areflexia. There are very few case reports of Ross syndrome in dermatology literature, most presenting with patchy hyperhidrosis. Here, we report two isolated cases who had presented to the emergency department with heat exhaustion. Multidisciplinary evaluations of the first case revealed focal anhidrosis, patchy hyperhidrosis, postural hypotension, absent deep tendon reflex, and tonic pupil while the second case had similar features except for postural hypotension, prompting the diagnosis of Ross syndrome. Presentation of these two patients highlights the importance of a high index of suspicion of dysautonomic disorder, interdisciplinary workup of a case of patchy anhidrosis, or hyperhidrosis, which may get missed in busy outpatient department (OPD) visit.
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Affiliation(s)
- Gautam K. Singh
- Department of Dermatology, Venereology and Leprosy, Base Hospital Delhi Cantt, Affiliated Faculty, Army College of Medical Sciences, New Delhi, India
| | - Sandeep Arora
- Department of Dermatology, Base Hospital Delhi Cantt, Affiliated Faculty, Army College of Medical Sciences New Delhi, India
| | - Amit Bahuguna
- Department of Dermatology, Venereology and Leprosy, Base Hospital Delhi Cantt, Affiliated Faculty, Army College of Medical Sciences, New Delhi, India,Address for correspondence: Dr. Amit Bahuguna, Department of Dermatology, Venereology and Leprosy, Base Hospital Delhi Cantt, Affiliated Faculty, Army College of Medical Sciences, New Delhi - 110 010, India. E-mail:
| | - Pankaj Das
- Department of Dermatology, Venereology and Leprosy, Base Hospital Delhi Cantt, Affiliated Faculty, Army College of Medical Sciences, New Delhi, India
| | - Prashant Bellad
- Department of Dermatology, Venereology and Leprosy, Base Hospital Delhi Cantt, Affiliated Faculty, Army College of Medical Sciences, New Delhi, India
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Rendón Fernández H, Arias Del Peso B. [Adiés tonic pupil and other associated signs]. Aten Primaria 2021; 53:101982. [PMID: 33689993 PMCID: PMC7941084 DOI: 10.1016/j.aprim.2021.101982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/09/2020] [Indexed: 10/26/2022] Open
Affiliation(s)
| | - Borja Arias Del Peso
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España
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Damagatla M, Ganne P, Upparakadiyala R, N P. Ross Syndrome. Neuroophthalmology 2020; 44:201-203. [PMID: 32395175 DOI: 10.1080/01658107.2019.1669184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/03/2019] [Accepted: 09/15/2019] [Indexed: 10/25/2022] Open
Abstract
Ross syndrome is a rare disorder of thermoregulation and includes a triad of tonic pupil, anhidrosis/hypohidosis and areflexia. Here we describe one such case in a 40-year-old woman. A general awareness among physicians, dermatologists and ophthalmologists regarding this disease can alleviate unnecessary anxiety and avoid unnecessary investigations.
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Affiliation(s)
- Manikanta Damagatla
- Department of Ophthalmology, All India Institute of Ophthalmology, Guntur, India
| | - Pratyusha Ganne
- Department of Ophthalmology, All India Institute of Ophthalmology, Guntur, India
| | | | - Prabhakaran N
- Department of Dermatology, All India Institute of Ophthalmology, Guntur, India
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Panda S, Verma D, Budania A, Bharti JN, Sharma RK. Clinical and laboratory correlates of selective autonomic dysfunction due to Ross syndrome. J Family Med Prim Care 2019; 8:1500-1503. [PMID: 31143750 PMCID: PMC6510077 DOI: 10.4103/jfmpc.jfmpc_151_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ross syndrome is diagnosed by the presence of the characteristic triad of segmental anhidrosis, depressed deep tendon reflex, and tonic pupils. It is a rare, misdiagnosed autonomic disorder with less than 80 cases reported in the world literature. Two representative cases of Ross syndrome are presented with their laboratory correlates and relevant review of literature. Both cases (aged 35 and 58) presented with complaint of decreased sweating over one half of the face and ipsilateral upper limb and trunk and contralateral lower limb. There was compensatory increased sweating and hyperpigmentation over the remaining parts of the body. The duration of symptoms was 2 years and 15 days. The patients had variegated skin color as per the above distribution and hyporeflexia in lower limbs. One patient also had Holmes-Adie pupil. Iodine test showed hypohidrosis in the described areas, which was confirmed by skin biopsy in both cases. The patients were treated symptomatically with incomplete relief. The authors aim to highlight this rare disorder that can be one of the causes of pathological sweating encountered in general practice and the challenges in its management.
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Affiliation(s)
- Samhita Panda
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Diwakar Verma
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Anil Budania
- Department of Dermatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jyotsna N Bharti
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rajesh K Sharma
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Affiliation(s)
- K Shikino
- Department of General Medicine, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-city, Chiba Japan
| | - M Miyahara
- Department of General Medicine, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-city, Chiba Japan
| | - M Ikusaka
- Department of General Medicine, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-city, Chiba Japan
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