Reverse Shapiro's Syndrome Revisited-Reply

In reply We thank Jeret for pointing out other cases of Shapiro's syndrome and for describing another proposed form of treatment (total sympathectomy) for this syndrome. In our article, 1 we did cite the study by Noel et al 2 that described their findings at autopsy. Postmortem pathologic findings were documented in the article by Pineda et al 3 ; however, the examination revealed diffuse severe spongiosis of the white matter and some of the subcortical nuclei. This made it difficult to determine the lesion responsible for the hypothermia. There were three other cases 4-6 that were similar to the 15 cases cited by us. Carr-Locke and Millac 7 proposed total sympathectomy as a possible form of treatment. Fox et al 8 treated their patient, who had spontaneous periodic hypothermia, without agenesis of the corpus callosum, using this form of treatment. However, the majority of patients with Shapiro's syndrome 5-7,9-12 showed