Motor paresis improved by sympathetic block. A motor form of reflex sympathetic dystrophy?
T. Yokota, T. Furukawa and H. Tsukagoshi
Department of Neurology, Tokyo, Japan Medical and Dental University.
Four patients had a characteristic motor paresis that was dramatically
improved by sympathetic block. The cause of this paresis could not be
determined by the usual neurological examinations. It was similar to reflex
sympathetic dystrophy in that the patients experienced severe pain,
swelling, coldness, and muscle atrophy in the affected limbs or other parts
of the body in the course of their illness. However, the motor paresis
could precede the pain or develop after the pain had disappeared. Even in
the absence of pain, the motor paresis was exacerbated by sympathetic
stimulation using epinephrine, norepinephrine (nor-adrenalin), or
isoproterenol hydrochloride (Proternol) loading and was improved by
regional intravenous infusion of reserpine or by sympathetic ganglion
block. Loading with pilocarpine, atropine sulfate (Bosmin), and edrophonium
chloride (Antirex) did not influence the paresis. This motor paresis is
thought to be due to abnormally increased sympathetic tone and may be
considered a motor form of reflex sympathetic dystrophy. However, motor
paresis closely related to sympathetic dysfunction is quite a new condition
that we call "sympathetic motor paresis." This is important clinically
because a long-standing effect can be expected from permanent sympathetic
ganglion block with dehydrated ethanol.