[Causalgia in the upper limbs following neck trauma: existence of widespread dysfunction of sympathetic postganglionic fibers]

Abstract

The functions of autonomic nervous system were systematically evaluated in a case of causalgia in the upper limbs after neck trauma. A 14-year-old boy had had hard blow on his nucha in a rough fight. After one week, a sustained burning pain, swelling and skin color change developed in the left upper limb. These symptoms also appeared in the right upper limb after 6 weeks. The physical examinations disclosed edema, reddish moist skin, and atrophic nail in the upper limbs. The neurological examinations showed a radiating pain to the upper limbs caused by the neck movement or pressure on the supraclavicular fossae, weakness of the upper limbs and left lower limb, and loss of sensation in the 5th to 8th cervical and first thoracic dermatomal segments. Deep tendon reflexes were diminished in the upper limbs and exaggerated in the lower limbs. Neither Horner syndrome nor sphincter disturbance was observed. He was diagnosed as being the cervicothoracic radiculopathy and cervical myelopathy due to the mechanical force. The burning pain disappeared with oral administration of guanethidine. On the examinations of the autonomic functions, the sweating response to the thermal stimulation was absent above the 5th thoracic dermatomal segment. The sweating response to the intradermal acetylcholine was decreased in the second and third thoracic dermatomal segments. The systolic hypotension with increasing pulse rate occurred on standing. The reactive elevation of the blood pressure to the intravenous tyramine was absent. The excessive elevation of the systolic blood pressure was induced by the subcutaneous injection of epinephrine. These results indicated the dysfunction of the sympathetic postganglionic sudomotor and vasomotor fibers.(ABSTRACT TRUNCATED AT 250 WORDS)