東京女子医大病院神経内科入院患者における発汗障害例の検討(神経内科学教室竹宮敏子教授退任記念特別号)

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  • The Examination of Dyshidrosis in Patients with Hospitalized in Department of Neurology, Tokyo Women's Medical University Hospital(Special Issue in Hornor of the Retirement of Professor Toshiko Takemiya at the Department of Neurology, Tokyo Women's Medical University)

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神経内科学教室竹宮敏子教授退任記念特別号

We examined retrospectively the medical records on patients with dyshidrosis in department of Neurology, Neurological institute, Tokyo Women's Medical University Hospital from January 1979 until May 2000. Causative diseases of dyshidrosis are primary autonomic failure including pure progressive autonomic failure (pure PAF) PAF with multiple system atrophy (MSA), or Shy-Drager syndrome (SDS). Olivo-ponto-cerebellar atrophy (OPCA), acute pandysautonomia, familial amyloidpolyneuropathy, diabetes mellitus, scleroderma, infarction of the spinal cord, calcification of the thoracic yellow ligament, Brown-Sequard syndrome, brainstem encephalitis and botulism. Also included are Harlequin syndrome, idiopathic segmental anhidrosis and mental hyperhidrosis on the base of localized dyshidrosis. Four cases of pure PAF revealed postganglionic sudomotor dysfunction and the sympathetic postganglionic dysfunction of cardiac, vasomotor and pupillary system associated with parasympathetic nervous system failure. Dyshidrosis was seen in 70.5% of patients with SDS, 20.9% with OPCA and 20% with unclassified MSA. Urinary disturbances were seen in all of patients with SDS, with OPCA, with unclassified MSA. On the other hand, orthostatic hypotension was seen in 75 % of patients with OPCA, 50% with unclassified MSA, and 100% with SDS. In SDS, OPCA, unclassified MSA, either pre- or postganglionic sudomotor dysfunction was observed according to causes. In comparing, the group of OPCA patients with dyshidrosis with the group without it, the duration of illness was statistically significantly longer in the group with dyshidrosis than in the group without it. As the frequency of autonomic dysfunctions other than dyshidrosis was higher in-group with dyshidrosis than that in dyshidrosis was considered to be a clinical manifestation of the wide spread and the advanced stage of autonomic dysfunction after long duration of illness.

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