Excessive sweating associated with cervical canal stenosis confirmed by microneurography recordings

Excessive sweating associated with cervical canal stenosis confirmed by microneurography recordings | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Excessive sweating associated with cervical canal stenosis confirmed by microneurography recordings Kazumasa Shindo, Tatsuya Saito, Yuto Morishima, Atsuhiko Shindo, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5927455/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 May, 2025 Read the published version in Clinical Autonomic Research → Version 1 posted 5 You are reading this latest preprint version Abstract We report a rare case of cervical canal stenosis (CCS) accompanied by excessive sweating recording skin sympathetic nerve activity (SSNA). The characteristic pattern of SSNA and other parameters in relation to sweating or cutaneous blood flow are detailed and evaluated here. cervical canal stenosis excessive sweating microneurography skin sympathetic nerve activity sympathetic descending pathway Figures Figure 1 Introduction Sweating abnormalities associated with cervical lesions, excluding spinal cord injuries, have been reported in several cases [ 1 – 5 ]. The location and occurrence of hyperhidrosis or decreased sweating often vary in each patient [ 2 ]. Although the reported incidence of abnormal sweating in patients with cervical lesions is not low [ 3 ], cases of excessive sweating due to cervical canal stenosis (CCS) with skin sympathetic nerve activity (SSNA) recorded by microneurographic methods have not been reported to date. We report a rare case of CCS accompanied by excessive sweating recording SSNA. The characteristic pattern of SSNA and other parameters in relation to sweating or cutaneous blood flow are detailed and evaluated here. Case presentation A 73-year-old Japanese man was admitted to our hospital with a one-year history of excessive sweating on bilateral face and bilateral upper body and a six-month history of gradually worsening muscle weakness in the right upper extremity. His past history and family history were unremarkable. Neurological findings included muscle weakness confined to the right arm, a decreased deep tendon reflex in the right upper limb, and reduced sense of touch and pain below the C5 spine level. His autonomic symptoms included excessive sweating, including during winter, and pollakiuria. Laboratory blood chemistry tests including thyroid function, chest and abdominal computed tomography (CT), electrocardiography, and cerebrospinal fluid analysis were all normal. F wave conduction studies at the median nerve for neurophysiological investigations revealed mild decreased velocity (39.1 m/sec) and reduced occurrence rate (25%). Fibrillation and high amplitude of motor unit potentials were found in the right greater pectoral and biceps brachii muscles by needle electromyography. His brain MRI was unremarkable. Cervical MRI revealed canal stenosis from C4 to C7 with no abnormal signal intensity in the spinal cord. We diagnosed excessive sweating and motor weakness of the right upper limb due to CCS. The patient was referred for physical therapy and received neck traction for six months. The muscle weakness in his right upper limb gradually improved, and excessive sweating of the face ceased, although upper body hyperhidrosis persisted. Physiological methods To determine the pathogenesis of excessive sweating in this case with CSS, we recorded SSNA in the peroneal nerve by using the microneurographic technique and measured the sympathetic skin response (SSR), the laser doppler flowmetry in relation to sweating and cutaneous blood flow at the right foot according to the methods and instruments described previously [ 8 , 9 ]. All examinations were carried out in a semidarkened room with the subject relaxed in the supine position. The below measurements were performed from September to October consecutively . Subjects ate 3 h before being examined. The room temperature was maintained at 24°C to 26°C. If the skin temperature was less than 32°C, the lower limbs were warmed. SSNA was elicited and recorded by using the microneurographic method described previously [ 8 , 9 ]. SSNA was identified on the basis of multiple characteristics such as irregular occurrence of spontaneous bursts without pulse synchrony; bursts induced by a loud voice, electric stimuli (ES) , or deep inspiration; and a constant relationship between the spontaneous bursts and changes of skin blood flow demonstrated by laser flowmetry or SSR. With the subject in the supine position, SSNA was recorded directly from right peroneal nerve fascicles at the popliteal fossa by tungsten microelectrodes. The electrodes were connected to a preamplifier (model LI-75A; NF Circuit Design Block, Yokohama, Japan) with a gain of 100 and to an amplifier (model AVN-10; Nihon Kohden, Tokyo, Japan) with a gain of 500. A band-pass filter of 500 to 2000 Hz was used. To obtain a mean-voltage neurogram, the filtered neurogram was fed into a resistance capacitance integrating unit (model EI-601G; Nihon Kohden) at a time constant of 0.1 s. Sympathetic skin response (SSR) was recorded according to the method described previously [ 8 ]. Surface electrodes were applied to the sole and the dorsum of the right foot and stimulation was delivered to the ankle on the same side where SSNA was recorded. A band-pass filter of 0.5 to 1000 Hz was used. Cutaneous blood flow was recorded in the foot using a laser Doppler flowmeter (model ALF21; Advance, Tokyo) to measure the skin vasomotor reflex (SVR) elicited by electrical ES at 30-s intervals according to the method described previously [ 8 ]. A laser probe was attached to the dorsum of the right foot. SSNA, SSR, and SVR were monitored on an oscilloscope (model VC-10; Nihon Kohden), and the data were recorded simultaneously on a thermal array recorder (model RTA1200; Nihon Kohden) at a paper speed of 5 mm/s. Data recording was preceded by a 15-min rest. The electrical stimuli were single square-wave pulses of 0.1 ms (30 to 90 mA) applied randomly to the skin at the level of the ankle at varying intervals of at least 30 s. Each stimulus was delivered 20 to 30 times. We confirmed that SSNA bursts recorded in this study were vasoconstrictive by reduced response of cutaneous blood flow following SSNA bursts. The following parameters were measured: the frequency of SSNA (bursts/min), mean amplitude of SSNA bursts, and spontaneous changes of SVR and SSR frequency (/min) at rest and during mental arithmetic stress. Investigators who were unaware of the clinical profile of the patient identified SSNA bursts and assessed the response of blood flow to ES by inspecting mean voltage neurogram, SSR and laser Doppler flowmetry records. Data were fed into a computer (PC-E550; Sharp, Osaka, Japan), and amplitudes were measured by using a digitizer (DST-4AN model 30; Pentel, Tokyo, Japan). To obtain data for this patient, the mean values of the eight parameters were calculated at consecutive recording sites where investigators could easily identify SSNA bursts for ten minutes. Results The recordings in this case were irregular, spontaneous, with no pulse-synchronous discharges (Fig. 1 ). Although the resting frequency of SSNA bursts was mildly low (13.5 ± 2.4 bursts/min [institutional reference range: 16.8 ± 4.2 bursts/min]), t he frequency of SSNA bursts induced by mental arithmetic stress was accelerated (31.2 ± 4.4 bursts/min [institutional reference range: 21.8 ± 2.3 bursts/min]). The amplitude of SSNA bursts at rest was low (5.3 ± 1.6 µV [institutional reference range: 10.1 ± 2.9 µV]). In addition, the increase of the amplitude induced by mental arithmetic stress was slightly low (8.6 ± 2.6 µV [institutional reference range: 13.6 ± 3.9 µV]). Spontaneous changes in SSR at rest were slightly reduced (2.7 ± 1.8/min [institutional reference range: 4.2 ± 1.3/min]). However, spontaneous changes in SSR during mental arithmetic stress were elevated (8.4 ± 2.1/min [institutional reference range: 6.2 ± 2.5/min]). Spontaneous skin blood flow changes showed a normal range at rest and during mental arithmetic stress. Although reduced spontaneous changes in SSR at rest and elevated spontaneous changes in SSR during mental arithmetic stress at the right hand were confirmed, SSNA from the median nerve could not be simultaneously recorded. Discussion Previous reports have indicated the occurrence of excessive sweating due to cervical lesions, including cervical spondylosis, disc herniation, vertebral anomaly, or spinal infarction, excluding spinal cord injury. Abnormal excessive sweating was generally observed bilaterally in the hands, trunk, lower limbs, and feet and unilaterally on the face [ 1 – 5 ]. The possible pathophysiological mechanisms were reported that impaired sympathetic descending pathway of the spinal cord, compression to cervical sympathetic nerves, or somatosympathetic reflex due to repeated compression to sensory nerves by spondylotic spine may induce excessive sweating. The another mechanism was also reported that compensatory hyperhidrosis on the face accompanied by decreased sweating in the trunk or limbs due to cervical lesions may be occurred. Sun et al. reported that 41% (n = 133) of cases with cervical spondylosis had the atypical symptom of facial flushing or excessive sweating because of continuous stimulation to the cervical sympathetic nerve by the spondylotic spine [ 3 ]. In regards to the pathophysiology in our case, we speculate that the excessive sweating may have originated from an impaired sympathetic excitatory descending pathway, because the frequency of SSNA bursts was low at rest and the amplitude of SSNA bursts was reduced during mental arithmetic stress, though elevated frequency of SSNA bursts was observed by this stress. Cutaneous blood flow changes might show a normal range during mental arithmetic stress, since the vasomotor component in SSNA is usually suppressed when excessive sweating is occurred [ 10 ]. Since the location of the spinal sympathetic descending pathway in relation to sweating or cutaneous blood flow is not precisely identified [ 4 , 5 , 7 ] and the location or pattern of excessive sweating abnormalities widely varies [ 1 – 6 ], cervical lesions should be investigated using radiological examination when cases with symptoms of sweating abnormality of unknown origin are encountered. Abbreviations CCS cervical canal stenosis SSNA skin sympathetic nerve activity SSR skin sympathetic response SVR sympathetic vasomotor reflex. ES electrical stimuli Declarations Author contributions: Conceptualization: Kazumasa Shindo, Tatsuya Saito; Organization: Yuto Morishima, Atsuhiko Shindo, Execution: Kazumasa Shindo, Hiroaki Murata; Statistical Analysis: Takanori Hata, Yuji Ueno, Design: Kazumasa Shindo; Execution Kazumasa Shindo, Tatsuya Saito; Review and editing; Kazumasa Shindo, Yuto Morishima, Yuji Ethical approval and informed consent: The study protocol was approved by the ethics committee of the Japan Microneurography Society. Informed consent was obtained from the patient for publication of data. Conflict of Interest: None of the authors has any conflict of interest to disclose. Funding: There is no funding in this study. References Iwase S, Inukai Y, Nishimura N, Sato M, Sugenoya J (2014) Hemifacial hyperhidrosis associated with ipsilateral/contralateral cervical disc herniation myelopathy. Functional considerations on how compression pattern determines the laterality. Funct Neurol 29 (1): 67-73. Marin-Lambies C, Espana-Gegori E, Gallego-Pinazo R, Climent-Vallano L, Muelas N, Diaz-Llopis M (2012) Pourfour du petit syndrome associated with a cervical vertebral anomaly. J Neuro-Ophthalmol 32 (2): 348-349. Sun Y-Q, Zheng S, Yu J, Yan K, Tian W (2013) Effect of total disc replacement on atypical symptoms associated with cervical spondylosis. Eur Spine J 22 (5): 1553-1557. Saito H, Tateyama M (1996) Continuous hyperhidrosis of hands and lower half of the body in a patient with a spinal cord lesion. Auton Nerv Syst 33 (6): 509-516 (in Japanese). Saito H (2009) Hypothalamo-spinal tract somatotopic organization determined from thermal sudomotor function in patients with localized intramedullary cervical lesions. Auton Nerv Syst 46 (6): 582-588 (in Japanese). Kitae S, Okazaki M, Tachiki N, Murata Y, Harada T, Ishizaki F, Nakamura S (1999) Palmoplantar hyperhidrosis treated successfully with mecobalamin. Auton Nerv Syst 36 (5): 499-503 (in Japanese). Nathan PW, Smith MC (1986) The locateon of descending fibers to sympathyetic neurons supplying the eye and sudomotor neurons supplying the head and neck. J Neurol Neurosurg Psychiatry 49 (5): 187-194. Shindo K, Iida H, Watanabe H, Ohta E, Nagasaka T, Shiozawa Z (2008) Sympathetic sudomotor and vasoconstrictive neural function in patients with Parkinson’s disease. Parkinsonism Relat Disord 14 (5): 548-552. Shindo K, Fukao T, Kurita N, Satake A, Tsuchiya M, Ichinose Y, Hata T, Koh K, Nagasaka T, Takiyama Y (2020) Sympathetic outflow to skin predicts central autonomic dysfunction in multiple system atrophy. Neurol Sci 41 (3): 2241-2248. Mano t, Iwase S, Toma S (2006) Microneurography as a tool in clinical neurophysiology to investing peripheral neural traffic in humans. Clin Neurophysiol 117 (11): 2357-2384. Cite Share Download PDF Status: Published Journal Publication published 11 May, 2025 Read the published version in Clinical Autonomic Research → Version 1 posted Editorial decision: Accept 27 Apr, 2025 Reviewers agreed at journal 29 Mar, 2025 Reviewers invited by journal 28 Mar, 2025 Editor assigned by journal 28 Mar, 2025 First submitted to journal 27 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5927455","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":435480460,"identity":"27e0dd45-4611-4959-b33d-e0674d175b97","order_by":0,"name":"Kazumasa Shindo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIiWNgGAWjYBACCQYehgMMbAxyMIEENjDFQ1iLMWlaGIBaEhtgWgg6TLL/7MHDBWU26RuOn078XFBTl8fHwPzwA4PMHZxapCXyEg7POJeWu+FM7mbpGccOF7MxsBkD7X6GU4ucBI/BYd62w7kbDuRukOZhO5DYxsBgBvTLYdxa+M+AtaQbnH+7+TfPvzqgFvZveLVIM+SAtSQY3MjdJs3bxgzUwoPfFskZQC0859IMZ954u82at+9wYhszT7FEAh6/SJw/Y/yZp8xGnu987ubbPN/qEue3t2/88LEHd4jBgcIBGIsZiBN7DuBUCQfyDSjcH0RoGQWjYBSMgpECAKefVa41Zdi1AAAAAElFTkSuQmCC","orcid":"","institution":"University of Yamanashi","correspondingAuthor":true,"prefix":"","firstName":"Kazumasa","middleName":"","lastName":"Shindo","suffix":""},{"id":435480461,"identity":"ecce9187-ebe8-454f-8689-219464a2b11c","order_by":1,"name":"Tatsuya Saito","email":"","orcid":"","institution":"University of Yamanashi: Yamanashi Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Tatsuya","middleName":"","lastName":"Saito","suffix":""},{"id":435480462,"identity":"4e01d6cc-5a7a-4653-a0d4-cd30074f6638","order_by":2,"name":"Yuto Morishima","email":"","orcid":"","institution":"University of Yamanashi: Yamanashi Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Yuto","middleName":"","lastName":"Morishima","suffix":""},{"id":435480463,"identity":"cc7769cd-38f3-462d-a654-e216532676a9","order_by":3,"name":"Atsuhiko Shindo","email":"","orcid":"","institution":"University of Yamanashi: Yamanashi Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Atsuhiko","middleName":"","lastName":"Shindo","suffix":""},{"id":435480464,"identity":"26a8c1de-df3d-4f43-bb09-4682f405d00c","order_by":4,"name":"Hiroaki Murata","email":"","orcid":"","institution":"University of Yamanashi: Yamanashi Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Hiroaki","middleName":"","lastName":"Murata","suffix":""},{"id":435480465,"identity":"598846fd-180f-4ff5-a86e-257459f04b57","order_by":5,"name":"Takanori Hata","email":"","orcid":"","institution":"University of Yamanashi: Yamanashi Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Takanori","middleName":"","lastName":"Hata","suffix":""},{"id":435480466,"identity":"c4c203a6-7f0b-40f1-a3f1-6db2dc6816cf","order_by":6,"name":"Yuji Ueno","email":"","orcid":"","institution":"University of Yamanashi: Yamanashi Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Yuji","middleName":"","lastName":"Ueno","suffix":""}],"badges":[],"createdAt":"2025-01-30 04:04:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5927455/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5927455/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10286-025-01133-9","type":"published","date":"2025-05-11T15:57:27+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79732818,"identity":"7e214dd5-8a0b-427a-ae30-3de07481ad9c","added_by":"auto","created_at":"2025-04-02 06:16:54","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":85157,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative recordings\u003cstrong\u003e \u003c/strong\u003eof\u003cstrong\u003e \u003c/strong\u003esympathetic skin response（SSR, top trace）, skin sympathetic nerve activity (SSNA, middle trace), laser Doppler flowmetry (bottom trace) at rest (A), during mental arithmetic stress (B). Arrows indicate electrical stimuli.\u003cstrong\u003e \u003c/strong\u003eAlthough resting SSNA bursts and SSR showed low levels, remarkable elevation of SSNA bursts and SSR was confirmed by mental arithmetic stress.\u003c/p\u003e","description":"","filename":"Figure1.tiff.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5927455/v1/dfb90d20c0080d913b2c06c3.jpg"},{"id":82537733,"identity":"55501b88-2a05-486f-b33c-225ebc79d2f9","added_by":"auto","created_at":"2025-05-12 16:10:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":403633,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5927455/v1/47bc95ca-d467-4e58-98b1-4189c116c88a.pdf"}],"financialInterests":"","formattedTitle":"Excessive sweating associated with cervical canal stenosis confirmed by microneurography recordings","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSweating abnormalities associated with cervical lesions, excluding spinal cord injuries, have been reported in several cases [\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The location and occurrence of hyperhidrosis or decreased sweating often vary in each patient [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although the reported incidence of abnormal sweating in patients with cervical lesions is not low [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], cases of excessive sweating due to cervical canal stenosis (CCS) with skin sympathetic nerve activity (SSNA) recorded by microneurographic methods have not been reported to date. We report a rare case of CCS accompanied by excessive sweating recording SSNA. The characteristic pattern of SSNA and other parameters in relation to sweating or cutaneous blood flow are detailed and evaluated here.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 73-year-old Japanese man was admitted to our hospital with a one-year history of excessive sweating on bilateral face and bilateral upper body and a six-month history of gradually worsening muscle weakness in the right upper extremity. His past history and family history were unremarkable. Neurological findings included muscle weakness confined to the right arm, a decreased deep tendon reflex in the right upper limb, and reduced sense of touch and pain below the C5 spine level. His autonomic symptoms included excessive sweating, including during winter, and pollakiuria. Laboratory blood chemistry tests including thyroid function, chest and abdominal computed tomography (CT), electrocardiography, and cerebrospinal fluid analysis were all normal. F wave conduction studies at the median nerve for neurophysiological investigations revealed mild decreased velocity (39.1 m/sec) and reduced occurrence rate (25%). Fibrillation and high amplitude of motor unit potentials were found in the right greater pectoral and biceps brachii muscles by needle electromyography. His brain MRI was unremarkable. Cervical MRI revealed canal stenosis from C4 to C7 with no abnormal signal intensity in the spinal cord. We diagnosed excessive sweating and motor weakness of the right upper limb due to CCS. The patient was referred for physical therapy and received neck traction for six months. The muscle weakness in his right upper limb gradually improved, and excessive sweating of the face ceased, although upper body hyperhidrosis persisted.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePhysiological methods\u003c/h2\u003e \u003cp\u003eTo determine the pathogenesis of excessive sweating in this case with CSS, we recorded SSNA in the peroneal nerve by using the microneurographic technique and measured the sympathetic skin response (SSR), the laser doppler flowmetry in relation to sweating and cutaneous blood flow at the right foot according to the methods and instruments described previously [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. All examinations were carried out in a semidarkened room with the subject relaxed in the supine position. The below measurements were performed from September to October \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003econsecutively\u003c/span\u003e. Subjects ate 3 h before being examined. The room temperature was maintained at 24\u0026deg;C to 26\u0026deg;C. If the skin temperature was less than 32\u0026deg;C, the lower limbs were warmed.\u003c/p\u003e \u003cp\u003eSSNA was elicited and recorded by using the microneurographic method described previously [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. SSNA was identified on the basis of multiple characteristics such as irregular occurrence of spontaneous bursts without pulse synchrony; bursts induced by a loud voice, \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eelectric stimuli (ES)\u003c/span\u003e, or deep inspiration; and a constant relationship between the spontaneous bursts and changes of skin blood flow demonstrated by laser flowmetry or SSR.\u003c/p\u003e \u003cp\u003eWith the subject in the supine position, SSNA was recorded directly from right peroneal nerve fascicles at the popliteal fossa by tungsten microelectrodes. The electrodes were connected to a preamplifier (model LI-75A; NF Circuit Design Block, Yokohama, Japan) with a gain of 100 and to an amplifier (model AVN-10; Nihon Kohden, Tokyo, Japan) with a gain of 500. A band-pass filter of 500 to 2000 Hz was used. To obtain a mean-voltage neurogram, the filtered neurogram was fed into a resistance capacitance integrating unit (model EI-601G; Nihon Kohden) at a time constant of 0.1 s.\u003c/p\u003e \u003cp\u003eSympathetic skin response (SSR) was recorded according to the method described previously [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Surface electrodes were applied to the sole and the dorsum of the right foot and stimulation was delivered to the ankle on the same side where SSNA was recorded. A band-pass filter of 0.5 to 1000 Hz was used. Cutaneous blood flow was recorded in the foot using a laser Doppler flowmeter (model ALF21; Advance, Tokyo) to measure the skin vasomotor reflex (SVR) elicited by electrical ES at 30-s intervals according to the method described previously [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. A laser probe was attached to the dorsum of the right foot.\u003c/p\u003e \u003cp\u003eSSNA, SSR, and SVR were monitored on an oscilloscope (model VC-10; Nihon Kohden), and the data were recorded simultaneously on a thermal array recorder (model RTA1200; Nihon Kohden) at a paper speed of 5 mm/s. Data recording was preceded by a 15-min rest. The electrical stimuli were single square-wave pulses of 0.1 ms (30 to 90 mA) applied randomly to the skin at the level of the ankle at varying intervals of at least 30 s. Each stimulus was delivered 20 to 30 times. We confirmed that SSNA bursts recorded in this study were vasoconstrictive by reduced response of cutaneous blood flow following SSNA bursts.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eThe following parameters were measured: the frequency of SSNA (bursts/min), mean amplitude of SSNA bursts, and spontaneous changes of SVR and SSR frequency (/min) at rest and during mental arithmetic stress. Investigators who were unaware of the clinical profile of the patient identified SSNA bursts and assessed the response of blood flow to ES by inspecting mean voltage neurogram, SSR and laser Doppler flowmetry records. Data were fed into a computer (PC-E550; Sharp, Osaka, Japan), and amplitudes were measured by using a digitizer (DST-4AN model 30; Pentel, Tokyo, Japan). To obtain data for this patient, the mean values of the eight parameters were calculated at consecutive recording sites where investigators could easily identify SSNA bursts for ten minutes.\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe recordings in this case were irregular, spontaneous, with no pulse-synchronous discharges (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Although the resting frequency of SSNA bursts was mildly low (13.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4 bursts/min [institutional reference range: 16.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 bursts/min]), \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003et\u003c/span\u003ehe frequency of SSNA bursts induced by mental arithmetic stress was accelerated (31.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4 bursts/min [institutional reference range: 21.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3 bursts/min]). The amplitude of SSNA bursts at rest was low (5.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 \u0026micro;V [institutional reference range: 10.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9 \u0026micro;V]). In addition, the increase of the amplitude induced by mental arithmetic stress was slightly low (8.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6 \u0026micro;V [institutional reference range: 13.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9 \u0026micro;V]). Spontaneous changes in SSR at rest were slightly reduced (2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8/min [institutional reference range: 4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3/min]). However, spontaneous changes in SSR during mental arithmetic stress were elevated (8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1/min [institutional reference range: 6.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5/min]). Spontaneous skin blood flow changes showed a normal range at rest and during mental arithmetic stress. Although reduced spontaneous changes in SSR at rest and elevated spontaneous changes in SSR during mental arithmetic stress at the right hand were confirmed, SSNA from the median nerve could not be simultaneously recorded.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrevious reports have indicated the occurrence of excessive sweating due to cervical lesions, including cervical spondylosis, disc herniation, vertebral anomaly, or spinal infarction, excluding spinal cord injury. Abnormal excessive sweating was generally observed bilaterally in the hands, trunk, lower limbs, and feet and unilaterally on the face [\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eThe possible pathophysiological mechanisms were reported that impaired sympathetic descending pathway of the spinal cord, compression to cervical sympathetic nerves, or somatosympathetic reflex due to repeated compression to sensory nerves by spondylotic spine may induce excessive sweating. The another mechanism was also reported that compensatory hyperhidrosis on the face accompanied by decreased sweating in the trunk or limbs due to cervical lesions may be occurred.\u003c/span\u003e Sun et al. reported that 41% (n\u0026thinsp;=\u0026thinsp;133) of cases with cervical spondylosis had the atypical symptom of facial flushing or excessive sweating because of continuous stimulation to the cervical sympathetic nerve by the spondylotic spine [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eIn regards to the pathophysiology in our case, we speculate that the excessive sweating may have originated from an impaired sympathetic excitatory descending pathway, because the frequency of SSNA bursts was low at rest and the amplitude of SSNA bursts was reduced during mental arithmetic stress, though elevated frequency of SSNA bursts was observed by this stress.\u003c/span\u003e Cutaneous blood flow changes might show a normal range during mental arithmetic stress, since the vasomotor component in SSNA is usually suppressed when excessive sweating is occurred [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSince the location of the spinal sympathetic descending pathway in relation to sweating or cutaneous blood flow is not precisely identified [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and the location or pattern of excessive sweating abnormalities widely varies [\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], cervical lesions should be investigated using radiological examination when cases with symptoms of sweating abnormality of unknown origin are encountered.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCCS \u0026nbsp; cervical canal stenosis\u003c/p\u003e\n\u003cp\u003eSSNA \u0026nbsp;skin sympathetic nerve activity\u003c/p\u003e\n\u003cp\u003eSSR \u0026nbsp; skin sympathetic response\u003c/p\u003e\n\u003cp\u003eSVR \u0026nbsp; sympathetic vasomotor reflex.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eES \u0026nbsp; \u0026nbsp;electrical stimuli\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: Kazumasa Shindo, Tatsuya Saito; Organization: Yuto Morishima, Atsuhiko Shindo, Execution: Kazumasa Shindo, Hiroaki Murata; Statistical Analysis: Takanori Hata, Yuji Ueno, Design: Kazumasa Shindo; Execution Kazumasa Shindo, Tatsuya Saito; Review and editing; Kazumasa Shindo, Yuto Morishima, Yuji\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and informed consent:\u003c/strong\u003e The study protocol was approved by the ethics committee of the Japan Microneurography Society.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from the patient for publication of data.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eNone of the authors has any conflict of interest to disclose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e There is no funding in this study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eIwase S, Inukai Y, Nishimura N, Sato M, Sugenoya J (2014) Hemifacial hyperhidrosis associated with ipsilateral/contralateral cervical disc herniation myelopathy. Functional considerations on how compression pattern determines the laterality. Funct Neurol 29 (1): 67-73. \u003c/li\u003e\n\u003cli\u003eMarin-Lambies C, Espana-Gegori E, Gallego-Pinazo R, Climent-Vallano L, Muelas N, Diaz-Llopis M (2012) Pourfour du petit syndrome associated with a cervical vertebral anomaly. J Neuro-Ophthalmol 32 (2): 348-349. \u003c/li\u003e\n\u003cli\u003eSun Y-Q, Zheng S, Yu J, Yan K, Tian W (2013) Effect of total disc replacement on atypical symptoms associated with cervical spondylosis. Eur Spine J 22 (5): 1553-1557.\u003c/li\u003e\n\u003cli\u003eSaito H, Tateyama M (1996) Continuous hyperhidrosis of hands and lower half of the body in a patient with a spinal cord lesion. Auton Nerv Syst 33 (6): 509-516 (in Japanese).\u003c/li\u003e\n\u003cli\u003eSaito H (2009) Hypothalamo-spinal tract somatotopic organization determined from thermal sudomotor function in patients with localized intramedullary cervical lesions. Auton Nerv Syst 46 (6): 582-588 (in Japanese).\u003c/li\u003e\n\u003cli\u003eKitae S, Okazaki M, Tachiki N, Murata Y, Harada T, Ishizaki F, Nakamura S (1999) Palmoplantar hyperhidrosis treated successfully with mecobalamin. Auton Nerv Syst 36 (5): 499-503 (in Japanese).\u003c/li\u003e\n\u003cli\u003eNathan PW, Smith MC (1986) The locateon of descending fibers to sympathyetic neurons supplying the eye and sudomotor neurons supplying the head and neck. J Neurol Neurosurg Psychiatry 49 (5): 187-194.\u003c/li\u003e\n\u003cli\u003eShindo K, Iida H, Watanabe H, Ohta E, Nagasaka T, Shiozawa Z (2008) Sympathetic sudomotor and vasoconstrictive neural function in patients with Parkinson\u0026rsquo;s disease. Parkinsonism Relat Disord 14 (5): 548-552.\u003c/li\u003e\n\u003cli\u003eShindo K, Fukao T, Kurita N, Satake A, Tsuchiya M, Ichinose Y, Hata T, Koh K, Nagasaka T, Takiyama Y (2020) Sympathetic outflow to skin predicts central autonomic dysfunction in multiple system atrophy. Neurol Sci 41 (3): 2241-2248.\u003c/li\u003e\n\u003cli\u003eMano t, Iwase S, Toma S (2006) Microneurography as a tool in clinical neurophysiology to investing peripheral neural traffic in humans. Clin Neurophysiol 117 (11): 2357-2384. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"clinical-autonomic-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"autr","sideBox":"Learn more about [Clinical Autonomic Research](http://link.springer.com/journal/10286)","snPcode":"10286","submissionUrl":"https://www.editorialmanager.com/autr/default2.aspx","title":"Clinical Autonomic Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"cervical canal stenosis, excessive sweating, microneurography, skin sympathetic nerve activity, sympathetic descending pathway","lastPublishedDoi":"10.21203/rs.3.rs-5927455/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5927455/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWe report a rare case of cervical canal stenosis (CCS) accompanied by excessive sweating recording skin sympathetic nerve activity (SSNA). The characteristic pattern of SSNA and other parameters in relation to sweating or cutaneous blood flow are detailed and evaluated here.\u003c/p\u003e","manuscriptTitle":"Excessive sweating associated with cervical canal stenosis confirmed by microneurography recordings","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-02 06:16:50","doi":"10.21203/rs.3.rs-5927455/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accept","date":"2025-04-28T00:58:39+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2025-03-29T20:59:09+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-28T17:15:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-28T13:21:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"Clinical Autonomic Research","date":"2025-03-27T20:59:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"clinical-autonomic-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"autr","sideBox":"Learn more about [Clinical Autonomic Research](http://link.springer.com/journal/10286)","snPcode":"10286","submissionUrl":"https://www.editorialmanager.com/autr/default2.aspx","title":"Clinical Autonomic Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"841067cb-239e-4d8e-915a-facc0915a411","owner":[],"postedDate":"April 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-12T16:07:11+00:00","versionOfRecord":{"articleIdentity":"rs-5927455","link":"https://doi.org/10.1007/s10286-025-01133-9","journal":{"identity":"clinical-autonomic-research","isVorOnly":false,"title":"Clinical Autonomic Research"},"publishedOn":"2025-05-11 15:57:27","publishedOnDateReadable":"May 11th, 2025"},"versionCreatedAt":"2025-04-02 06:16:50","video":"","vorDoi":"10.1007/s10286-025-01133-9","vorDoiUrl":"https://doi.org/10.1007/s10286-025-01133-9","workflowStages":[]},"version":"v1","identity":"rs-5927455","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5927455","identity":"rs-5927455","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}