Although not commonly reported, autonomic dysfunction (other than disturbances of bowel and bladder) may be noted. Abnormal sweating has been described, and some patients have coldness or discoloration of the legs or feet (168,169a,169b). Autonomous respiration, a syndrome in which the patient loses voluntary control of breathing, has been described (170). Respiratory failure may rarely occur as a result of bilateral diaphragmatic paralysis with or even without significant quadri-paresis (170-172).
Several patients who experienced acute relapses associated with hypothermia have been reported (173). Most of the patients were severely disabled and all displayed signs during relapse of other brainstem lesions, suggesting that the hypothermia may be secondary to brainstem, rather than hypothalamic, involvement. Thrombocytopenia commonly accompanied the disturbed temperature regulation.
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