Below the level of the sympathetic chain interruption, body temperature is significantly lower, creating a stark contrast that can be observed on thermal images. The difference in temperatures between the sympathetically under- and overactive regions can be as high as 10 Celsius. Variations
Gustatory sweating or Freys syndrome is another presentation of autonomic neuropathy. Gustatory sweating is brought on while eating, thinking or talking about food that produces a strong salivary stimulus. It is thought that ANS fibres to salivary glands have become connected in error with the sweat glands after nerve regeneration. Apart from sweating in the anhidriotic area of the body, it can produce flushing, goosebumps, drop of body temperature - vasoconstriction and paresthesia. Aberrant gustatory sweating follows up to 73% of surgical sympathectomies and is particularly common after bilateral procedures. Facial sweating during salivation has also been described in diabetes mellitus, cluster headache, following chorda tympani injury, and following facial herpes zoster.Phantom sweating is another form of autonomic neuropathy. It can be observed in patients with nerve damage (following accidents), diabetes mellitus and as a result of sympathectomy. Phantom sweating is a sensation that one is sweating, while the skin remains dry. Affected people can not distinguish whether it is real sweating or just a sensation. The phenomena is experienced in the anhidriotic, denervated area of the body, presenting an abnormal sympathetic nervous system function.
In adults, foreign body aspiration is most prevalent in populations with impaired swallowing mechanisms such as the following: neurological disorders, alcohol use, advanced age leading to senility (most common in the 6th decade of life), and loss of consciousness. This inadequate airway protection may also be attributed to poor dentition, seizure, general anesthesia, or sedative drug use. Diagnosis
The most important aspect of the assessment for a clinician is an accurate history provided by an event witness. Unfortunately, this is not always available. Physical examination
A physical examination by a clinician should include, at a minimum, a general assessment in addition to cardiac and pulmonary exams. Auscultation of breath sounds may give additional information regarding object location and the degree of airway obstruction. The presence of drooling and dysphagia (drooling) should always be noted alongside the classic signs of airway obstruction as these can indicate involvement of the esophagus and impact management. Diagnostic Imaging
Radiography is the most common form of imaging used in the initial assessment of a foreign body presentation. Most patients receive a chest x-ray to determine the location of the foreign body. Lateral neck, chest, and bilateral decubitus end-expiratory chest x-rays should be obtained in patients suspected of having aspirated a foreign body. However, the presence of normal findings on chest radiography should not rule out foreign body aspiration as not all objects can be visualized. In fact, up to 50% of cases can have normal findings on radiography.