horner 's syndrome , along with weakness and atrophy of upper limb , as well as anaesthesia to pain and temperature , is well recognized finding in patients with syringomyelia .
few cases have been reported regarding isolated horner 's syndrome as a presenting manifestation of a chiari i malformation with syringomyelia .
we report a 41 year old man with left side hemi hidrosis probably a part of horner 's syndrome who was found to have a chiari i malformation with holocord syrinx .
a 41-year - old man presented in medicine ward with a complaint of neck and back pain and loss of sweating in right side of the body that had begun eight months before .
there was no history of hypertension , diabetes , and immunocompromised status . on examination whole left side of body including face was dry , there was no evidence of sweating [ figures 1 and 2 ] .
this test is described as drawing a metal spoon across the surface of the skin after adequate physical exercise .
neurological examination was unremarkable with no limb weakness , wasting or numbness and temperature impairment on the side of anhidrosis .
this was done to rule out any mass in the upper lobe of the lung which may present as horner syndrome .
mri spine was performed which showed hyperintense signal ( red arrow head ) in t2-weighted sections extending whole spinal cord up to eighth thoracic cord level with herniation of cerebellar tonsil ( blue arrow head ) compatible with syringomyelia along with chiari i malformation [ figure 3 ] .
dry left nipple with anhyrosis holocord syrinx up to 8 spinal cord level ( red arrow head ) , herniation of cerebellar tonsil ( blue arrow head )
syringomyelia is the development of a fluid - filled cavity or syrinx within the spinal cord .
more than half of all cases are associated with chiari type 1 malformations in which the cerebellar tonsils protrude through the foramen magnum and into the cervical spinal canal .
it may occur after a trauma , secondary to a tumor , craniocervical or intracerebral pathology or idiopathic .
fibers originating in the cerebral cortex traverse the hypothalamus , and then cross in the medulla to the lateral horn of the spinal cord .
these fibers leave the spinal cord to synapse in the sympathetic ganglia with neurons that innervate the sweat glands .
thus , a cortical lesion will cause contralateral anhidrosis , a lesion in the medulla could result in contralateral or ipsilateral anhidrosis , and any lesion distal to the medulla will cause ipsilateral anhidrosis .
slowly progressive tissue damage around the syrinx reaches the lateral horn , it will segmentally affect the sympathetic preganglionic neurons or adjacent structures .
search for publications dealing with anhidrosis in syringomyelia there was lack of information regarding this . in our case probable hypothesis may be hypo activity due to autonomic disturbances because of progressive and irreversible damage to the sympathetic preganglionic neurons due to expanding syrinx .
physicians should be aware of the different ways in which syringomyelia can present to ensure its early diagnosis .
anhidrosis of the face and upper part of the body , segmental anhidrosis is reported in horner syndrome and syringomyelia but hemi hidrosis of the whole boy was unique in this case .
 we present a 41-year - old man with chiari type 1 malformation and syrinx up to tenth thoracic level who presented with left side hemi anhidrosis . neurological findings of syrinx were absent in this case . 
 though horner 's syndrome is reported , this report is probably first . 
INTRODUCTION
CASE REPORT
DISCUSSION