If Anse had been a lifelong sufferer from anhidrosis
, it is unlikely that he would have been able to prepare to court Addie by building a new house.
Mutations in the TrkA gene have been shown to be responsible for congenital insensitivity to pain with anhidrosis
(CIPA), a rare genetic disorder characterized by a lack of pain sensation.
1-3) Horner's syndrome characteristically presents with the tetrad of ptosis, miosis, anhidrosis
and apparent enophthalmos secondary to a reduced palpebral fissure from upper-lid ptosis and elevation of the lower lid, so-called inverted ptosis.
The constellation of ptosis, miosis, and anhidrosis
in our patient suggested the diagnosis of Horner's syndrome.