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Central Neurogenic Hyperventilation in Man

Central Neurogenic Hyperventilation in Man Abstract Centrally caused respiratory facilitation was first suggested to us by the unusually heavy breathing of several patients recovering from the effects of transient exposures to acute anoxia. There was no carboxyhemoglobin, persisting anoxemia, cardiac disease, or pulmonary abnormality to stimulate a compensatory hyperpnea; yet several overbreathed themselves into clinical tetany while still in deep coma. Subsequently, the same respiratory pattern was observed in patients with hypoglycemia, severe head injuries, and acute cerebral vascular lesions. Several of these patients were in younger age groups and were completely free of cardiopulmonary disease. Autopsies showed severe brain stem changes, but either the lesions were too diffuse to afford specific conclusions on the neuroanatomy involved or the respiratory changes had not been quantitated adequately. Descriptions of "forced," "heavy," or "stertorous" breathing in the case reports of patients with fulminating meningitis,1,2 basilar artery thrombosis,3,4 pontile hemorrhage,5 and encephalitis6 supported the impression References 1. Smith, H. V.; Norman, R. M., and Urich, H.: The Late Sequelae of Pneumococcal Meningitis , J. Neurol. Neurosurg. & Psychiat. 20:250-259 ( (Nov.) ) 1957. 2. Eschwege, J.: Generalized Moniliasis with Localization in the Brain , A. M. A. Arch. Neurol. & Psychiat. 79:250-263 ( (March) ) 1958. 3. Kubik, C. S., and Adams, R. D.: Occlusion of the Basilar Artery—a Clinical and Pathological Study , Brain 69:73-121 ( (June) ) 1946. 4. Fang, H. C. H., and Palmer, J. J.: Vascular Phenomena Involving Brainstem Structures: A Clinical and Pathologic Correlation Study , Neurology 6:402-419 ( (June) ) 1956. 5. Steegmann, A. T.: Primary Pontile Hemorrhage with Particular Reference to Respiratory Failure , J. Nerv. & Ment. Dis. 114:35-65 ( (July) ) 1951. 6. Harrop, G. A., and Loeb, R. F.: Uncompensated Alkalosis in Encephalitis , J. A. M. A. 81: 452-454 ( (Aug. 11) ) 1923. 7. Singer, R. B., and Hastings, A. B.: An Improved Clinical Method for the Estimation of Disturbances of the Acid-Base Balance of Human Blood , Medicine 27:223-242 ( (May) ) 1948. 8. Nathanson, M.; Bergman, P. S., and Anderson, P. J.: Significance of Oculocephalic and Caloric Responses in the Unconscious Patient , Neurology 7:829-832 ( (Dec.) ) 1957. 9. Tenney, S. M.: Ventilatory Response to Carbon Dioxide in Pulmonary Emphysema , J. Appl. Physiol. 6:477-484 ( (Feb.) ) 1954. 10. Alexander, J. K.; West, J. R.; Wood, J. A., and Richards, D. W.: Analysis of the Respiratory Response to Carbon Dioxide Inhalation in Varying Clinical States of Hypercapnia, Anoxia, and Acid-Base Derangement , J. Clin. Invest. 34:511-532 ( (April) ) 1955. 11. Pitt, G. N.; Pembrey, M. S., and Allen, R. W.: Observations upon Cheyne-Stokes' Respiration , Tr. Med.-chir. Soc. Edinburgh 90:49-82 ( (March) ) 1907. 12. Douglas, C. G., and Haldane, J. S.: The Causes of Periodic or Cheyne-Stokes Breathing , J. Physiol. 38:401-419 ( (June 15) ) 1909. 13. Kety, S. S.; Polis, B. D.; Nadler, C. S., and Schmidt, C. F.: The Blood Flow and Oxygen Consumption of the Human Brain in Diabetic Acidosis and Coma , J. Clin. Invest. 27:500-510 ( (July) ) 1948. 14. Harrop, G. A.: The Oxygen and Carbon Dioxide Content of Arterial and of Venous Blood in Normal Individuals and in Patients with Anemia and Heart Disease , J. Exper. Med. 30:241-257 ( (Sept. 1) ) 1919. 15. Fraser, F. R.; Harris, C. F.; Hilton, R., and Linder, G. C.: Arterial Carbon Dioxide Pressure in Cardiac Dyspnoea , Quart. J. Med. 22:1-20 ( (Oct.) ) 1928. 16. Fishberg, A. M.: Heart Failure , Ed. 2, Philadelphia, Lea & Febiger, 1940. 17. Harrison, T. R.; Calhoun, J. A.; Cullen, G. E.; Wilkens, W. F., and Pilcher, C.: Studies in Congestive Heart Failure: XV. Reflex Versus Chemical Factors in the Production of Rapid Breathing , J. Clin. Invest. 11:133-154 ( (Jan.) ) 1932. 18. Harrison, T. R.; Harrison, W. G.; Calhoun, J. A., and March, J. P.: Congestive Heart Failure: XVII. The Mechanism of Dyspnea on Exertion , Arch. Int. Med. 50:690-720 ( (Nov.) ) 1932. 19. Sarnoff, S. J., and Sarnoff, L. C.: Neurohemodynamics and Pulmonary Edema: II. The Role of Sympathetic Pathways in the Elevation of Pulmonary and Systemic Vascular Pressure Following the Intracisternal Injection of Fibrin , Circulation 6:51-62 ( (July) ) 1952. 20. Gamble, J. E., and Patton, H. D.: Pulmonary Edema and Hemorrhage from Preoptic Lesions in Rats , Am. J. Physiol. 172:623-631 ( (March) ) 1953. 21. Baker, A. B.: Poliomyelitis: 16. A Study of Pulmonary Edema , Neurology 7:743-756 ( (Nov.) ) 1957. 22. Dubowitz, V.: Influenzal Encephalitis , Lancet 1:140-141 ( (Jan. 18) ) 1958.Crossref 23. Schmidt, C. F.: The Influence of Cerebral Blood-Flow on Respiration: I. The Respiratory Responses to Changes in Cerebral Blood Flow , Am. J. Physiol. 84:202-222 ( (Feb.) ) 1928. 24. Shenkin, H. A.; Novak, P.; Goluboff, B.; Soffe, A. M., and Bortin, L.: The Effects of Aging, Arteriosclerosis, and Hypertension upon the Cerebral Circulation , J. Clin. Invest. 32:459-465 ( (June) ) 1953.Crossref 25. Vanamee, P.; Poppell, J. W.; Glicksman, A. S.; Randall, H. T., and Roberts, K. E.: Respiratory Alkalosis in Hepatic Coma , A. M. A. Arch. Int. Med. 97:762-767 ( (June) ) 1956.Crossref 26. Fazekas, J. F.; Ticktin, H. E.; Ehrmantraut, W. R., and Alman, R. W.: Cerebral Metabolism in Hepatic Insufficiency , Am. J. Med. 21:843-849 ( (Dec.) ) 1956.Crossref 27. Plum, F., and Swanson, A. G.: Abnormalities in Central Regulation of Respiration in Acute and Convalescent Poliomyelitis , A. M. A. Arch. Neurol. & Psychiat. 80:267-285 ( (Sept.) ) 1958. 28. Ngai, S. H.: Pulmonary Ventilation Studies on Pontile and Medullary Cats , Am. J. Physiol. 190:356-360 ( (Aug.) ) 1957. 29. Ngai, S. H., and Wang, S. C.: Organization of Central Respiratory Mechanisms in the Brain Stem of the Cat: Localization by Stimulation and Destruction , Am. J. Physiol. 190:343-349 ( (Aug.) ) 1957. 30. Scott, M., and Lennon, H. C.: Decerebrate Tonic Extensor Convulsions as a Sign of Occlusion of the Basilar Artery , Arch. Neurol. & Psychiat. 44:1102-1108 ( (Nov.) ) 1940. 31. Ward, A. A., Jr.: Decerebrate Rigidity , J. Neurophysiol. 10:89-105 ( (March) ) 1947. 32. Heymann, A.; Birchfield, R. I., and Sieker, H. O.: Effects of Bilateral Cerebral Infarction on Respiratory Center Sensitivity , Neurology 8: 694-700, 1958. 33. Harrison, T. R.: Failure of the Circulation , Baltimore, Williams & Wilkins Company, 1939. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives of Neurology & Psychiatry American Medical Association

Central Neurogenic Hyperventilation in Man

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Publisher
American Medical Association
Copyright
Copyright © 1959 American Medical Association. All Rights Reserved.
ISSN
0096-6886
DOI
10.1001/archneurpsyc.1959.02340170001001
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Abstract

Abstract Centrally caused respiratory facilitation was first suggested to us by the unusually heavy breathing of several patients recovering from the effects of transient exposures to acute anoxia. There was no carboxyhemoglobin, persisting anoxemia, cardiac disease, or pulmonary abnormality to stimulate a compensatory hyperpnea; yet several overbreathed themselves into clinical tetany while still in deep coma. Subsequently, the same respiratory pattern was observed in patients with hypoglycemia, severe head injuries, and acute cerebral vascular lesions. Several of these patients were in younger age groups and were completely free of cardiopulmonary disease. Autopsies showed severe brain stem changes, but either the lesions were too diffuse to afford specific conclusions on the neuroanatomy involved or the respiratory changes had not been quantitated adequately. Descriptions of "forced," "heavy," or "stertorous" breathing in the case reports of patients with fulminating meningitis,1,2 basilar artery thrombosis,3,4 pontile hemorrhage,5 and encephalitis6 supported the impression References 1. Smith, H. V.; Norman, R. M., and Urich, H.: The Late Sequelae of Pneumococcal Meningitis , J. Neurol. Neurosurg. & Psychiat. 20:250-259 ( (Nov.) ) 1957. 2. Eschwege, J.: Generalized Moniliasis with Localization in the Brain , A. M. A. Arch. Neurol. & Psychiat. 79:250-263 ( (March) ) 1958. 3. Kubik, C. S., and Adams, R. D.: Occlusion of the Basilar Artery—a Clinical and Pathological Study , Brain 69:73-121 ( (June) ) 1946. 4. Fang, H. C. H., and Palmer, J. J.: Vascular Phenomena Involving Brainstem Structures: A Clinical and Pathologic Correlation Study , Neurology 6:402-419 ( (June) ) 1956. 5. Steegmann, A. T.: Primary Pontile Hemorrhage with Particular Reference to Respiratory Failure , J. Nerv. & Ment. Dis. 114:35-65 ( (July) ) 1951. 6. Harrop, G. A., and Loeb, R. F.: Uncompensated Alkalosis in Encephalitis , J. A. M. A. 81: 452-454 ( (Aug. 11) ) 1923. 7. Singer, R. B., and Hastings, A. B.: An Improved Clinical Method for the Estimation of Disturbances of the Acid-Base Balance of Human Blood , Medicine 27:223-242 ( (May) ) 1948. 8. Nathanson, M.; Bergman, P. S., and Anderson, P. J.: Significance of Oculocephalic and Caloric Responses in the Unconscious Patient , Neurology 7:829-832 ( (Dec.) ) 1957. 9. Tenney, S. M.: Ventilatory Response to Carbon Dioxide in Pulmonary Emphysema , J. Appl. Physiol. 6:477-484 ( (Feb.) ) 1954. 10. Alexander, J. K.; West, J. R.; Wood, J. A., and Richards, D. W.: Analysis of the Respiratory Response to Carbon Dioxide Inhalation in Varying Clinical States of Hypercapnia, Anoxia, and Acid-Base Derangement , J. Clin. Invest. 34:511-532 ( (April) ) 1955. 11. Pitt, G. N.; Pembrey, M. S., and Allen, R. W.: Observations upon Cheyne-Stokes' Respiration , Tr. Med.-chir. Soc. Edinburgh 90:49-82 ( (March) ) 1907. 12. Douglas, C. G., and Haldane, J. S.: The Causes of Periodic or Cheyne-Stokes Breathing , J. Physiol. 38:401-419 ( (June 15) ) 1909. 13. Kety, S. S.; Polis, B. D.; Nadler, C. S., and Schmidt, C. F.: The Blood Flow and Oxygen Consumption of the Human Brain in Diabetic Acidosis and Coma , J. Clin. Invest. 27:500-510 ( (July) ) 1948. 14. Harrop, G. A.: The Oxygen and Carbon Dioxide Content of Arterial and of Venous Blood in Normal Individuals and in Patients with Anemia and Heart Disease , J. Exper. Med. 30:241-257 ( (Sept. 1) ) 1919. 15. Fraser, F. R.; Harris, C. F.; Hilton, R., and Linder, G. C.: Arterial Carbon Dioxide Pressure in Cardiac Dyspnoea , Quart. J. Med. 22:1-20 ( (Oct.) ) 1928. 16. Fishberg, A. M.: Heart Failure , Ed. 2, Philadelphia, Lea & Febiger, 1940. 17. Harrison, T. R.; Calhoun, J. A.; Cullen, G. E.; Wilkens, W. F., and Pilcher, C.: Studies in Congestive Heart Failure: XV. Reflex Versus Chemical Factors in the Production of Rapid Breathing , J. Clin. Invest. 11:133-154 ( (Jan.) ) 1932. 18. Harrison, T. R.; Harrison, W. G.; Calhoun, J. A., and March, J. P.: Congestive Heart Failure: XVII. The Mechanism of Dyspnea on Exertion , Arch. Int. Med. 50:690-720 ( (Nov.) ) 1932. 19. Sarnoff, S. J., and Sarnoff, L. C.: Neurohemodynamics and Pulmonary Edema: II. The Role of Sympathetic Pathways in the Elevation of Pulmonary and Systemic Vascular Pressure Following the Intracisternal Injection of Fibrin , Circulation 6:51-62 ( (July) ) 1952. 20. Gamble, J. E., and Patton, H. D.: Pulmonary Edema and Hemorrhage from Preoptic Lesions in Rats , Am. J. Physiol. 172:623-631 ( (March) ) 1953. 21. Baker, A. B.: Poliomyelitis: 16. A Study of Pulmonary Edema , Neurology 7:743-756 ( (Nov.) ) 1957. 22. Dubowitz, V.: Influenzal Encephalitis , Lancet 1:140-141 ( (Jan. 18) ) 1958.Crossref 23. Schmidt, C. F.: The Influence of Cerebral Blood-Flow on Respiration: I. The Respiratory Responses to Changes in Cerebral Blood Flow , Am. J. Physiol. 84:202-222 ( (Feb.) ) 1928. 24. Shenkin, H. A.; Novak, P.; Goluboff, B.; Soffe, A. M., and Bortin, L.: The Effects of Aging, Arteriosclerosis, and Hypertension upon the Cerebral Circulation , J. Clin. Invest. 32:459-465 ( (June) ) 1953.Crossref 25. Vanamee, P.; Poppell, J. W.; Glicksman, A. S.; Randall, H. T., and Roberts, K. E.: Respiratory Alkalosis in Hepatic Coma , A. M. A. Arch. Int. Med. 97:762-767 ( (June) ) 1956.Crossref 26. Fazekas, J. F.; Ticktin, H. E.; Ehrmantraut, W. R., and Alman, R. W.: Cerebral Metabolism in Hepatic Insufficiency , Am. J. Med. 21:843-849 ( (Dec.) ) 1956.Crossref 27. Plum, F., and Swanson, A. G.: Abnormalities in Central Regulation of Respiration in Acute and Convalescent Poliomyelitis , A. M. A. Arch. Neurol. & Psychiat. 80:267-285 ( (Sept.) ) 1958. 28. Ngai, S. H.: Pulmonary Ventilation Studies on Pontile and Medullary Cats , Am. J. Physiol. 190:356-360 ( (Aug.) ) 1957. 29. Ngai, S. H., and Wang, S. C.: Organization of Central Respiratory Mechanisms in the Brain Stem of the Cat: Localization by Stimulation and Destruction , Am. J. Physiol. 190:343-349 ( (Aug.) ) 1957. 30. Scott, M., and Lennon, H. C.: Decerebrate Tonic Extensor Convulsions as a Sign of Occlusion of the Basilar Artery , Arch. Neurol. & Psychiat. 44:1102-1108 ( (Nov.) ) 1940. 31. Ward, A. A., Jr.: Decerebrate Rigidity , J. Neurophysiol. 10:89-105 ( (March) ) 1947. 32. Heymann, A.; Birchfield, R. I., and Sieker, H. O.: Effects of Bilateral Cerebral Infarction on Respiratory Center Sensitivity , Neurology 8: 694-700, 1958. 33. Harrison, T. R.: Failure of the Circulation , Baltimore, Williams & Wilkins Company, 1939.

Journal

A.M.A. Archives of Neurology & PsychiatryAmerican Medical Association

Published: May 1, 1959

References