Central Autonomic Dysfunction With Defective Lacrimation

Five cases have been reported with symptoms and findings so similar as to constitute a clinical entity. The common features in this group are: 1. a deficiency of lacrimation; 2. an abnormal reaction to mild anxiety characterized by transient extreme elevation of blood pressure, excessive sweating, salivation to the point of drooling, and the development of sharply demarcated erythematous blotches on the skin, biliterally symmetric, and tending to recur in the same or similar configurations. The findings seem best interpreted as a central, possibly congenital, disturbance of autonomic function. An origin in the diencephalon has been suggested. The most difficult feature to interpret from a neurophysiologic point of view is diminished rather than excessive lacrimation.