Document Detail

Respiratory insufficiency due to high anterior cervical cord infarction.
MedLine Citation:
PMID:  9527149     Owner:  NLM     Status:  MEDLINE    
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.
R S Howard; J Thorpe; R Barker; T Revesz; N Hirsch; D Miller; A J Williams
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of neurology, neurosurgery, and psychiatry     Volume:  64     ISSN:  0022-3050     ISO Abbreviation:  J. Neurol. Neurosurg. Psychiatr.     Publication Date:  1998 Mar 
Date Detail:
Created Date:  1998-04-10     Completed Date:  1998-04-10     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  2985191R     Medline TA:  J Neurol Neurosurg Psychiatry     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  358-61     Citation Subset:  IM    
The Batten/Harris Unit, National Hospital for Neurology and Neurosurgery, London, UK.
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MeSH Terms
Fatal Outcome
Infarction / complications*,  diagnosis
Magnetic Resonance Imaging
Middle Aged
Respiration, Artificial
Respiratory Insufficiency / etiology*,  therapy
Spinal Cord / blood supply*

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