F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
305
FIG. 135.
Reflex sweating
The sweat gland activity in spinal paraplegics is not only of interest from a thermo-
regulatory point of view, but it also represents an outstanding component of widespread
reflex responses of the skeletal muscles and autonomic mechanisms (mass response), once
the uninhibited reflex activity of the isolated cord has developed (List & Pimenta, 1944;
Guttmann, 1953). Reflex sweating is elicited by many extrinsic and intrinsic stimuli in
the paralysed part of the body, and this has been described in the chapter on the bladder.
Head & Riddoch (1917), in their classical paper on reflex changes following transection
of the spinal cord, summarized the following circumstances which were found to preci
pitate reflex sweating below the lesion on the 259th day following transection of the cord
in an officer who was struck by shrapnel in the mid-thoracic region:
1
spasms of the legs, especially repeatedly induced flexion reflexes;
2
an enema;
3
catheterization;
4
change of temperature—e.g. when being lifted out of his bath sweating appeared
over his whole body, especially his lower extremities, but there was no change of pulse
or pupils during such hyperhidrosis.
From my own experience I can confirm this observation but further factors evoking
reflex sweating should be mentioned:
1
Change of posture, in particular in cervical lesions. In some patients, reflex sweating
may occur when a patient is placed in the prone position, in others when placed on one
side. Lately it was found in a tetraplegic when raised from the horizontal to the upright
position, in particular when standing in the parallel bars.
2 Any acute infection of the bladder or an acute pressure sore or following infection
from ingrowing toe-nails.
Details of reflex sweating elicited by bladder distension and hyperactivity are given
in section on bladder disturbances.
