The Significance of Temporary and Alternating Ptosis, Miosis and Anhidrosis

IIEN the spinal cord of man is injured, a wide variety of complex patterns of activity mav develop. Those such as the reflex actions of the somatic musculature?' 9 have been the subject of many recent writings. In those patients with injury above the fourth thoracic spinal segment, hypertension and peculiar sudomotor reactions 7 result from reflex stimulation of the afferent limbs of the sympathetic system--most potently induced through the segments supplied by the sacral nerves, s Occasionally such reflexes may be of such a disabling nature that they require surgical elimination. ~,1~ In the same general realm of interest are those sympathetic reflexes concerned with the face and eyes. A careful study has been done in regard to the ciliospinal reflex in patients with injury of the cervical spinal cord, 1 indicating that the afferent pathway is changed after injury. From all indications, the cervical sympathetic impulses operate independently of the abnormal reflex responses of the trunk and limbs. Perhaps the most intriguing finding made in an extensive experience with patients who have had injury to the cervical spinal cord has been a condition of ptosis, miosis, and anhidrosis which has been unilateral and temporary and which could be varied by altering the position of the patient. This report deals with 6 such patients in whom explanations for the changes appear to have been found.