Syndromes

Disturbances of thermoregulatory sweating. Examination: Useful tests include palpation of the skin to appreciate its moisture and temperature, the quantitative sudomotor axon reflex test (QSART), the sympathetic skin response (SSR), iodine-starch test (Minor test), and the ninhy-drin test.

Generalized anhidrosis (which confers a risk of hyperthermia) may be idiopathic or may be due to lesions in the hypothalamus or in the spinal cord above T3/4 . Monoradicular lesions or cervical or lumbosacral polyradicular lesions do not impair sweating. Lesions of the sympathetic trunk cause segmental anhidrosis. Plexus lesions and isolated or combined neuropathies produce anhidrosis in the area of a sensory deficit. Lesions from the level of the stellate ganglion upward cause anhidrosis as a component of Horner syndrome. Sweating of the palms and soles is not influenced by thermoregulatory mechanisms but rather by the emotional state (fear, nervousness).

Central hyperthermia may be due to hy-pothalamic lesions (infarction, hemorrhage, tumor, encephalitis, neurosarcoidosis, trauma), intoxications (anticholinergic agents, salicy-lates, amphetamines, cocaine), acute spinal cord transection above T3/4, delirium, catatonia, malignant neuroleptic syndrome, malignant hy-perthermia, dehydration, heat stroke, and generalized tetanus.

Fever. The symptoms include malaise, shivering, feeling cold, chills, nausea, vomiting, and somnolence. The heart rate and blood pressure rise, thermoregulatory sweating diminishes, and the peripheral blood volume is redistributed to the core of the body. Simple febrile convulsions in children under 5 years of age generally do not lead to epilepsy or other neurological complications.

Hypothalamic control center

Hypothalamic control center

Pathway Thermoreceptor

Afferent pathway (thermoreceptors)

Pregan-glionic sudoriparous fibers (T2/3-L2/3)

Innervation of sweat glands

Afferent pathway (thermoreceptors)

Pregan-glionic sudoriparous fibers (T2/3-L2/3)

Innervation of sweat glands

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