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February 1990

The Central Sites of the Autonomic Nervous System May Also Be Disturbed in Some Cases With Acute Pandysautonomia

Author Affiliations

Health Administration Center Hokkaido University Sapporo 060, Japan
Shintomi Ophthalmic Clinic Sapporo 064, Japan

Arch Neurol. 1990;47(2):127-128. doi:10.1001/archneur.1990.00530020021008

To the Editor.  —Acute pandysautonomia is a syndrome characterized by various symptoms of acute paralysis of the sympathetic and parasympathetic functions, apparently without other clinical or neurological abnormalities.1,2 Recovery is partial or complete after several months. The site of the lesion of acute pandysautonomia has generally been assumed to be located in the postganglionic fibers of both sympathetic and parasympathetic neurons.1-3 However, it was suggested that, in the second case of Okada et al3 and in the case of Watanabe et al,4 lesions were present in the preganglionic or central nervous system, because of poor vascular responses to subcutaneous or intravenous injection of sympathomimetic amines and no pupillary response to a low concentration of cocaine or epinephrine instillation in the eyes. Electroencephalographic abnormalities were described by Andersen et al,5 Harik et al,6 and Neville and Sladen.7 Hopkins et al8 described some temporal