Movement Disorders - Short Communication

Journal of Neural Transmission

, Volume 117, Issue 4, pp 475-479

The cold hand sign in multiple system atrophy: skin perfusion revisited

  • K. PietzarkaAffiliated withAutonomic and Neuroendocrinological Laboratory, Department of Neurology, University of Technology Dresden
  • , M. ReimannAffiliated withAutonomic and Neuroendocrinological Laboratory, Department of Neurology, University of Technology DresdenResearch Group Neuro-Metabolism, Department of Neurology and Medicine III, University of Technology Dresden
  • , C. SchmidtAffiliated withAutonomic and Neuroendocrinological Laboratory, Department of Neurology, University of Technology Dresden
  • , B. HertingAffiliated withParkinson Research Group, Department of Neurology, University of Technology Dresden
  • , L. SchölsAffiliated withDepartment of Neurodegenerative Disorders, Hertie Institute of Clinical Brain Research, University of Tübingen
  • , H. ReichmannAffiliated withParkinson Research Group, Department of Neurology, University of Technology Dresden
  • , D. BergAffiliated withDepartment of Neurodegenerative Disorders, Hertie Institute of Clinical Brain Research, University of Tübingen
  • , Christoph SchraderAffiliated withDepartment of Neurology, University of Hannover
  • , Tjalf ZiemssenAffiliated withAutonomic and Neuroendocrinological Laboratory, Department of Neurology, University of Technology DresdenResearch Group Neuro-Metabolism, Department of Neurology and Medicine III, University of Technology Dresden Email author 

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Abstract

The cold hand sign (CHS) is a distinct feature of multiple system atrophy (MSA), but its pathophysiology is poorly understood. We, therefore, conducted a study to examine the skin temperature and the skin blood flow at rest and after local heating in 6 age-matched MSA patients with CHS (MSA + CHS), 18 MSA patients without CHS (MSA – CHS) and 13 patients with idiopathic Parkinson’s disease (PD). Basal skin temperature and blood flow were significantly lower in MSA + CHS patients than in MSA – CHS or PD patients. Local heating induced a greater response in terms of amplitude in MSA + CHS compared to MSA – CHS and PD. Considering kinetics, skin blood flow increment per 1°C was higher in MSA + CHS than MSA – CHS but was similar when compared to PD patients. Skin blood flow rate (change per second) did not differ among the groups. Our findings suggest that despite impaired basal skin perfusion, the skin vasomotor response to local heating is intact in MSA + CHS but disturbed in MSA – CHS. By measuring skin temperature and blood flow, the presence of CHS can be diagnosed in MSA patients. Further studies are necessary to understand regulation of skin perfusion in patients with extrapyramidal disease.

Keywords

Autonomic nervous system Multiple system atrophy Autonomic dysfunction Cold hand sign Skin perfusion Parkinson’s disease