Question Title: Autonomic nervous system causing sweating addition

Forum: Neurology Forum
Topic: Autonomic

Dear G. Randolph:

1) Excessive sweating may occur in some individuals without any actual underlying problem or pathology, or contrarily it may represent what is termed "compenstory hyperhydrosis". This latter condition is best described in the setting of diabetic neuropathy, in which sweating function in the extremities is impaired or lost. As a consequence excesive sweating is observed in areas like the face or on the trunk. Anticholinergic agents such as belladonna extract might be appropriate in some individuals to control hyperhydrosis which is a major cosmetic and/or hygienic problem. This group of medicines, however, carries a significant risk of causing confusion and delirium in an individual as old as your mother, besides causing other irritating side effects as dry mouth, constipation, difficulty voiding, etc. Also, these agents are contraindicated in the presence of glaucoma.

2) Cuprolith repositioning procedures (Epley/Semont) are successful in more or less half of cases of "benign paroxysmal positional vertigo", if this condition is correctly diagnosed. These procedures commonly induce severe symptoms when they are performed, but should be curative (if successful) within several hours. In an individual of your mother's age, in my experience, cerebrovascular disease of the vertebrobasilar system ("VBI") is probably as common a cause of vertigo as BPPV is, and the two can be incredibly difficult to distinguish on clinical grounds. VBI is a serious problem and may be a harbinger of a devastating stroke, while BPPV is indeed a benign dislodgement of "stones" in the inner ear. Vertebrobasilar arterial disease is commonly diagnosed with an MRI-A.

Your mother needs a neurological consult.

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