A Case Of Relapsing Multiple Sclerosis Presenting With Only Autonomic Symptoms Including Orthostatic Hypotension, Hiccups And Vomiting
Kuba H, Arakawa K, Taniwaki T, Maeda Y, Yamada T, Kira J
Rinsho Shinkeigaku. 1999 Sep;39(9):930-4
Kyushu University, Graduate School of Medical Sciences, Department of Neurology
A 49-year-old woman, with a two-year-history of Multiple Screlosis (MS), noticed Postural Dizziness, Intractable Hiccups and Vomiting.
On admission, she had mild Quadriparesis, Hypesthesia below the C5 level, and a Girdle Sensation at the T5 and L1 levels. A CSF examination showed slight increases in the protein level (48 mg/dl) and cell count (7/mm3). Brain MRI demonstrated no obvious lesion in the Medulla Oblongata.
The Head-Up-Tilting Test showed a decrease in the blood pressure from 105/63 mmHg to 70/55 mmHg. The pulse rate, however, increased from 57/min to 72/min. The Cold Pressure Test also revealed a mild impairement in her blood pressure response.
The R-R interval variation (coefficient of variation: CVRR) during normal breathing was 2.58 (normal: > 1.66). The Valsalva Ratio was 1.84 (normal: 1.4-2.0).
The Aschner Eye-Ball Pressure Test, the blood pressure response to the injection of Epinephrine, and the Sweating Response to the injection of Acetylcholine were all normal.
She was thus administered Domperidone and Chlorpromazine. Only Domperidone effectively improved the Nausea and Vomiting.
All symptoms, including Orthostatic Hypotension, Hiccups and Vomiting, disappeared about one month after admission. The remission of her symptoms was considered to reflect the natural course of MS.
The results of Autonomic Nervous System function tests and her clinical features suggest that an irritable lesion in the Medullary Tegmentum, including the Nucleus Tractus Solitarii, most likely caused her symptoms.
The above findings indicate that Autonomic symptoms, such as Orthstatic Hypotension, Hiccups and Vomiting, may sometimes be the only symptoms observed in a relapse of MS.
Evaluation Of Sweating Function, Changes In Heart Function And Postural Blood Pressure In Patients With Multiple Sclerosis
Bilinska M, Pokryszko A, Gruszka E, Piechocki DW
Pol Merkuriusz Lek. 1998 Mar;4(21):150-3
Katedra i Klinika Neurologii AM we Wroclawiu
The aim of the study was ElectroPhysiologic assessment of Sudomotor Function and some aspects of CardioVascular System function in patients with Multiple Sclerosis and an attempt of referring assessed variables to duration of the disease and EDSS score.
The study included 24 patients with Clinically Definite, Relapsing/Remitting Multiple Sclerosis and 22 healthy, age-matched controls.
Autonomic functions were evaluated by means of clinical examination, Heart rate variability tests, measures of blood pressure in supine and standing position and Skin Sympathetic Response examination.
Clinical symptoms in patients with Multiple Sclerosis were scarce. ElectroPhysiologic tests showed no abnormalities in Heart rate variability and blood pressure response to standing in studied group.
The majority of patients presented with subclinical dysfunction of SudoMotor System, indicated by an abnormal Sympathetic Skin Response, which did not correlate with duration of the disease or EDSS score.
Sympathetic skin response examination proved to be a sensitive indicator of Autonomic disturbances in patients with Multiple Sclerosis.
Sympathetic VasoConstrictor Responses In Multiple Sclerosis With Thermo-Regulatory Dysfunction
Andersen EB, Nordenbo AM
Clin Auton Res 1997 Feb;7(1):13-6
Hvidovre University Hospital, Department of Neurology, Copenhagen, Denmark
Centrally and locally mediated Sympathetic VasoConstrictor Responses in skeletal muscle and subcutaneous tissue were studied in six patients with Definite Multiple Sclerosis and severely affected ThermoRegulatory Sweating.
The purpose of the study was to evaluate VasoMotor function in patients with pronounced ThermoRegulatory Dysfunction and to differentiate between locally and Centrally elicited VasoMotor Reflexes in two different tissues.
The method used, the 133-Xenon washout technique, makes such a distinction possible.
In spite of the severe Sweating disturbances, we found Centrally and locally mediated Sympathetic VasoMotor reflexes to be preserved in skeletal muscle and subcutaneous tissue.
The results support the view that SudoMotor and VasoMotor functions are independently controlled.
Previously described differences in Sympathetic VasoConstrictor Responses in skeletal muscle and subcutaneous tissue in several other Neurological Disorders are not present in patients with Multiple Sclerosis, based on our results.
HypoThermia In Multiple Sclerosis
White KD, Scoones DJ, Newman PK
J Neurol NeuroSurg Psychiatry. 1996 Oct;61(4):369-75
Middlesbrough General Hospital, Department of Neurology, Cleveland, UK
Five patients with Clinically Definite Multiple Sclerosis are reported who presented with acute relapses associated with HypoThermia. Repeated episodes of HypoThermia were seen in four.
ThromboCytopenia was associated with the HypoThermia in four patients. Further investigation disclosed a tendency to chronic HypoThermia and suggested an altered ThermoRegulatory set point in one patient.
When MRI, Endocrine, and Autonomic studies failed to localize a lesion in the HypoThalamus, but subsequent necropsy showed HypoThalamic lesions.
In such patients a predisposition to altered ThermoRegulation may occur due to direct involvement of the HypoThalamus or from combined lesions affecting HypoThalamic outflow to the BrainStem and Spinal Cord.