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RHYTHMIC VARIATION OF RESPIRATORY EXCURSION WITH BILATERAL INJURY OF CORTICAL EFFERENT FIBERS

RHYTHMIC VARIATION OF RESPIRATORY EXCURSION WITH BILATERAL INJURY OF CORTICAL EFFERENT FIBERS Abstract The majority of studies of respiration have been concerned with the respiratory center in the medulla and the factors which influence its activity. Little attention has been given to the control of higher centers over this lower reflex mechanism. Recently, we recorded tremulousness of respiratory movement in cases of palatal myoclonus (Langworthy and Grimmer1). In this syndrome there is degeneration of the central tegmental fasciculus, the inferior olivary nucleus and often the dentate nucleus of the cerebellum. In studying patients at the Baltimore City Hospitals we noticed that many with injury of the motor cortex on one or both sides showed a rhythmic variation of respiratory excursions. This was similar to Cheyne-Stokes respiration, especially in the more marked cases. These patients were not unconscious, nor did they have manifest circulatory inadequacy. Indeed, the respiratory changes persisted for weeks or months. In this paper we shall consider cases in which References 1. Langworthy, O. R., and Grimmer, R. V.: A Physiological Study of Abnormal Movements Observed in Palatal Myoclonus, with Particular Attention to the Respiratory Rhythm , Bull. Johns Hopkins Hosp. 65:101, 1939. 2. Kolb, L. C., and Kleyntjens, F.: A Clinical Study of Respiratory Movements in Hemiplegia , Brain 60:259, 1937.Crossref 3. Langworthy, O. R., and Hesser, F. H.: Syndrome of Pseudobulbar Palsy: An Anatomic and Physiologic Analysis , Arch. Int. Med. , to be published. 4. By forced expiration is meant any part of the expiratory phase that requires active participation of the musculature of the abdominal wall. Intra-abdominal pressure is passively increased in inspiration and actively increased in forced expiration. Thus, the pressure built up passively against the normal recoil of the abdominal muscles is utilized in quiet expiration as soon as the diaphragm relaxes. In the presence of a large abdominal panniculus, the amplitude of quiet inspiration is reduced, because the limit of intra-abdominal pressure against which the diaphragm must act is reached sooner. The required volume of tidal air is made up by forced expiration, after which the initial part of the subsequent quiet inspiration is effected by the downward pull of the panniculus and the abdominal parietes. At the same time this constant force tends to keep the diaphragm pulled down, reduces the supplemental air and may lead eventually to a state of emphysema. These movements are recorded faithfully in the pneumographic tracing. Hence, the pneumogram permits analysis of the sequence of activity of the respiratory muscles; it is inadequate in recording respiratory activity volumetrically. The spirometer records volumetrically, but inevitably interferes with gaseous exchange and does not allow interpretation of muscular activity. 5. Bucy, P. C., and Case, T. J.: Cortical Innervation of Respiratory Movements , J. Nerv. & Ment. Dis. 84:156, 1936. 6. Smith, W. K.: The Representation of Respiratory Movements in the Cerebral Cortex , J. Neurophysiol. 1:55, 1938. 7. Jackson, J. H.: Neurological Abstracts: XV. Superior and Subordinate Centres of the Lowest Level , Lancet 1:476, 1895. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology & Psychiatry American Medical Association

RHYTHMIC VARIATION OF RESPIRATORY EXCURSION WITH BILATERAL INJURY OF CORTICAL EFFERENT FIBERS

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Publisher
American Medical Association
Copyright
Copyright © 1939 American Medical Association. All Rights Reserved.
ISSN
0096-6754
DOI
10.1001/archneurpsyc.1939.02270230084006
Publisher site
See Article on Publisher Site

Abstract

Abstract The majority of studies of respiration have been concerned with the respiratory center in the medulla and the factors which influence its activity. Little attention has been given to the control of higher centers over this lower reflex mechanism. Recently, we recorded tremulousness of respiratory movement in cases of palatal myoclonus (Langworthy and Grimmer1). In this syndrome there is degeneration of the central tegmental fasciculus, the inferior olivary nucleus and often the dentate nucleus of the cerebellum. In studying patients at the Baltimore City Hospitals we noticed that many with injury of the motor cortex on one or both sides showed a rhythmic variation of respiratory excursions. This was similar to Cheyne-Stokes respiration, especially in the more marked cases. These patients were not unconscious, nor did they have manifest circulatory inadequacy. Indeed, the respiratory changes persisted for weeks or months. In this paper we shall consider cases in which References 1. Langworthy, O. R., and Grimmer, R. V.: A Physiological Study of Abnormal Movements Observed in Palatal Myoclonus, with Particular Attention to the Respiratory Rhythm , Bull. Johns Hopkins Hosp. 65:101, 1939. 2. Kolb, L. C., and Kleyntjens, F.: A Clinical Study of Respiratory Movements in Hemiplegia , Brain 60:259, 1937.Crossref 3. Langworthy, O. R., and Hesser, F. H.: Syndrome of Pseudobulbar Palsy: An Anatomic and Physiologic Analysis , Arch. Int. Med. , to be published. 4. By forced expiration is meant any part of the expiratory phase that requires active participation of the musculature of the abdominal wall. Intra-abdominal pressure is passively increased in inspiration and actively increased in forced expiration. Thus, the pressure built up passively against the normal recoil of the abdominal muscles is utilized in quiet expiration as soon as the diaphragm relaxes. In the presence of a large abdominal panniculus, the amplitude of quiet inspiration is reduced, because the limit of intra-abdominal pressure against which the diaphragm must act is reached sooner. The required volume of tidal air is made up by forced expiration, after which the initial part of the subsequent quiet inspiration is effected by the downward pull of the panniculus and the abdominal parietes. At the same time this constant force tends to keep the diaphragm pulled down, reduces the supplemental air and may lead eventually to a state of emphysema. These movements are recorded faithfully in the pneumographic tracing. Hence, the pneumogram permits analysis of the sequence of activity of the respiratory muscles; it is inadequate in recording respiratory activity volumetrically. The spirometer records volumetrically, but inevitably interferes with gaseous exchange and does not allow interpretation of muscular activity. 5. Bucy, P. C., and Case, T. J.: Cortical Innervation of Respiratory Movements , J. Nerv. & Ment. Dis. 84:156, 1936. 6. Smith, W. K.: The Representation of Respiratory Movements in the Cerebral Cortex , J. Neurophysiol. 1:55, 1938. 7. Jackson, J. H.: Neurological Abstracts: XV. Superior and Subordinate Centres of the Lowest Level , Lancet 1:476, 1895.

Journal

Archives of Neurology & PsychiatryAmerican Medical Association

Published: Nov 1, 1939

References