Abstract
OBJECTS AND METHODS—Respiratory dysfunction may occur as a result of lesions in the upper cervical spinal cord disturbing the descending pathways subserving automatic and volitional ventilatory control. Four patients are described who presented with acute respiratory insufficiency caused by infarction of the anterior portion of the upper cervical cord due to presumed anterior spinal artery occlusion. RESULTS—Two patients presented after respiratory arrests; they were ventilated and there was no automatic or volitional respiratory effort. Both had signs of an extensive anterior spinal cord lesion at the C2 level and this was confirmed by MRI. One patient presented with a C4 infarction and required ventilation for three months. Ventilatory recovery was characterised by the development of an automatic respiratory pattern. The fourth patient required ventilation for two months after infarction at the C3 level. On attempted weaning he had prolonged periods of hypoventilation and apnoea during inattention and sleep indicating impairment of automatic respiratory control. CONCLUSION—Infarction of the spinal cord at high cervical levels may be due to fibrocartilaginous embolism and involvement of the descending respiratory pathways may occur. Extensive lesions at C1/2 cause complete interruption of descending respiratory control leading to apnoea. Partial lesions at C3/4 cause selective interruption of automatic or voluntary pathways and give rise to characteristic respiratory patterns. The prognosis depends on the level and extent of the lesion.
Full Text
The Full Text of this article is available as a PDF (101.1 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- BELMUSTO L., BROWN E., OWENS G. CLINICAL OBSERVATIONS ON RESPIRATORY AND VASOMOTOR DISTURBANCE AS RELATED TO CERVICAL CORDOTOMIES. J Neurosurg. 1963 Mar;20:225–232. doi: 10.3171/jns.1963.20.3.0225. [DOI] [PubMed] [Google Scholar]
- Banerjee A. K., Deodhar S. D. Cartilage embolism of spinal cord. J Neurol Neurosurg Psychiatry. 1989 Oct;52(10):1201–1202. doi: 10.1136/jnnp.52.10.1201. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cheshire W. P., Santos C. C., Massey E. W., Howard J. F., Jr Spinal cord infarction: etiology and outcome. Neurology. 1996 Aug;47(2):321–330. doi: 10.1212/wnl.47.2.321. [DOI] [PubMed] [Google Scholar]
- Davis J. N. Autonomous breathing. Report of a case. Arch Neurol. 1974 Jun;30(6):480–483. doi: 10.1001/archneur.1974.00490360056011. [DOI] [PubMed] [Google Scholar]
- Howard R. S., Wiles C. M., Hirsch N. P., Loh L., Spencer G. T., Newsom-Davis J. Respiratory involvement in multiple sclerosis. Brain. 1992 Apr;115(Pt 2):479–494. doi: 10.1093/brain/115.2.479. [DOI] [PubMed] [Google Scholar]
- Krieger A. J., Rosomoff H. L. Sleep-induced apnea. 1. A respiratory and autonomic dysfunction syndrome following bilateral percutaneous cervical cordotomy. J Neurosurg. 1974 Feb;40(2):168–180. doi: 10.3171/jns.1974.40.2.0168. [DOI] [PubMed] [Google Scholar]
- McEvoy R. D., Mykytyn I., Sajkov D., Flavell H., Marshall R., Antic R., Thornton A. T. Sleep apnoea in patients with quadriplegia. Thorax. 1995 Jun;50(6):613–619. doi: 10.1136/thx.50.6.613. [DOI] [PMC free article] [PubMed] [Google Scholar]
- NATHAN P. W. THE DESCENDING RESPIRATORY PATHWAY IN MAN. J Neurol Neurosurg Psychiatry. 1963 Dec;26:487–499. doi: 10.1136/jnnp.26.6.487. [DOI] [PMC free article] [PubMed] [Google Scholar]
- O'Riordan J. I., Gallagher H. L., Thompson A. J., Howard R. S., Kingsley D. P., Thompson E. J., McDonald W. I., Miller D. H. Clinical, CSF, and MRI findings in Devic's neuromyelitis optica. J Neurol Neurosurg Psychiatry. 1996 Apr;60(4):382–387. doi: 10.1136/jnnp.60.4.382. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sandson T. A., Friedman J. H. Spinal cord infarction. Report of 8 cases and review of the literature. Medicine (Baltimore) 1989 Sep;68(5):282–292. [PubMed] [Google Scholar]
- Short D. J., Stradling J. R., Williams S. J. Prevalence of sleep apnoea in patients over 40 years of age with spinal cord lesions. J Neurol Neurosurg Psychiatry. 1992 Nov;55(11):1032–1036. doi: 10.1136/jnnp.55.11.1032. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Srigley J. R., Lambert C. D., Bilbao J. M., Pritzker K. P. Spinal cord infarction secondary to intervertebral disc embolism. Ann Neurol. 1981 Mar;9(3):296–301. doi: 10.1002/ana.410090315. [DOI] [PubMed] [Google Scholar]
- Tosi L., Rigoli G., Beltramello A. Fibrocartilaginous embolism of the spinal cord: a clinical and pathogenetic reconsideration. J Neurol Neurosurg Psychiatry. 1996 Jan;60(1):55–60. doi: 10.1136/jnnp.60.1.55. [DOI] [PMC free article] [PubMed] [Google Scholar]