Neurologic Complications of Respiratory Disease

doi:10.1016/S0733-8619(03)00062-8

Neurologic Clinics

Volume 20, Issue 1, February 2002, Pages 247-264

https://doi.org/10.1016/S0733-8619(03)00062-8 Get rights and content

Section snippets

Respiratory Insufficiency

The neurologic signs and symptoms seen with respiratory insufficiency are caused by hypoxia and hypercapnea.

Hypoxia, or lack of oxygen, is experienced by millions of people a day as a result of cardiac, pulmonary, or hematologic disorders; individuals in airplanes and at high altitudes are especially at risk for developing hypoxic symptoms. The effects of hypoxia are dependent on its severity, duration, and rate of onset. Therefore, the chronically hypoxic patient will have different symptoms

High-Altitude Sickness

Low barometric pressure at high altitudes and a low Po₂ cause stress on the nervous system, especially when introduced acutely. Historical reminders of this fact are the deaths of two of three scientists floating 8,000 meters above the ground in the hot air balloon Zenith in 1875.³⁴ Increasing numbers of sea-level denizens travel to high altitudes for recreation and adventure and are able to achieve these heights quite rapidly because of advances in modern transportation. Approximately 20% of

Sleep Apnea Syndromes

Sleep disorders caused by respiratory disturbances are common and have important clinical ramifications. In 1988, accidents at home, at work, and in traffic caused by sleep-related breathing disorders cost 40 to 50 billion dollars in the United States. Effective treatment reduces the incidence of traffic accidents per 100,000 km five-fold, and can significantly improve an individual's productivity.⁹

Sleep apneas are defined as the cessation of airflow at the nose and mouth during sleep and are

Hyperventilation Syndrome

The myriad symptoms of the hyperventilation syndrome (HS) are often unrecognized by many health care practitioners, including many neurologists. Physiologically inappropriate hyperventilation, whether under voluntary or unconscious control, can create somatic symptoms, both neurologic and non-neurologic. An estimated 6% to 11% of the general patient population may be affected with this syndrome, which occurs more frequently in women. In one study, 24% of patients presenting to a clinic with the

Summary

Alterations in the complex interplay between the respiratory system and the nervous system have a broad range of consequences, from mild paresthesias to coma. Early recognition of neurologic symptoms and their antecedent respiratory sources, combined with early intervention, may prevent further morbidity and mortality. Acute and chronic respiratory diseases alter brain and nerve function through several mechanisms, but the mainstay of treatment for these diseases is to return arterial oxygen

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References (40)

R Chervin et al.
Obstructive sleep apnea and related disorders
Neurol Clin
(1996)
C Guilleminault et al.
Central sleep apnea
Neurol Clin
(1996)
R Józefowicz
Neurologic manifestation of pulmonary disease
Neurol Clin
(1989)
D Klocke et al.
Altitude-related illnesses
Mayo Clin Proc
(1998)
FK Austen et al.
Neurologic manifestation of chronic pulmonary insufficiency
N Engl J Med
(1957)
T Bradley et al.
Sleep disorders
AJ Cameron
Marked papilloedema in pulmonary emphysema
Br J Ophthalmol
(1933)
R Cohen et al.
Neuropsychological effects of short-term discontinuation of oxygen therapyObservations in patients with chronic hypoxemia who are receiving long-term oxygen therapy
Arch Int Med
(1986)
A Culebras
R Evans
Neurologic aspects of hyperventilation syndrome
Semin Neurol
(1995)

K Ferguson et al.

Sleep-related breathing disorders: 4—Consequences of sleep disordered breathing

Thorax

(1995)

J Fischer et al.

Economic and medical significance of sleep-related breathing disorders

Respiration

(1997)

R Fishman

Cerebrospinal Fluid in Diseases of the Nervous System

R Griggs et al.

Neurologic manifestations of respiratory disease

C Guilleminault et al.

Sleep-related obstructive and nonobstructive apneas and neurologic disorders

Neurology

(1992)

RH Hackett et al.

Fluid retention and hypoventilation in acute mountain sickness

Respiration

(1982)

T Hornbein et al.

The cost to the central nervous system of climbing to extremely high altitude

N Engl J Med

(1989)

K Kilburn et al.

Neurologic manifestations of respiratory failure

Arch Intern Med

(1965)

DE Levy et al.

Brief hypoxia-ischemia initially damages cerebral neurons

Arch Neurol

(1975)

Cited by (18)

Neurological effects of respiratory dysfunction
2022, Handbook of Clinical Neurology
Citation Excerpt :
Around 2%–8% of individuals may progress to a more severe high-altitude cerebral edema heralded by the onset of ataxic gait, severe lassitude, impaired mentation, stupor and coma (Dreibelbis and Jozefowicz, 2010). Prophylactic measures, early recognition, and prompt treatment is essential in prevention of life-threatening consequences (Kirsch and Józefowicz, 2002; Dreibelbis and Jozefowicz, 2010). Gradual ascent is the main preventive measure.
The respiratory and the nervous systems are closely interconnected and are maintained in a fine balance. Central mechanisms maintain strict control of ventilation due to the high metabolic demands of brain which depends on a continuous supply of oxygenated blood along with glucose. Moreover, brain perfusion is highly sensitive to changes in the partial pressures of carbon dioxide and oxygen in blood, which in turn depend on respiratory function. Ventilatory control is strictly monitored and regulated by the central nervous system through central and peripheral chemoreceptors, baroreceptors, the cardiovascular system, and the autonomic nervous system. Disruption in this delicate control of respiratory function can have subtle to devastating neurological effects as a result of ensuing hypoxia or hypercapnia. In addition, pulmonary circulation receives entire cardiac output and this may act as a conduit to transmit infections and also for metastasis of malignancies to brain resulting in neurological dysfunction. Furthermore, many neurological paraneoplastic syndromes can have underlying lung malignancies resulting in respiratory dysfunction. It is essential to understand the underlying mechanisms and the resulting manifestations in order to prevent and effectively manage the many neurological effects of respiratory dysfunction. This chapter explores the various neurological effects of respiratory dysfunction with focus on their pathophysiology, etiologies, clinical features and long-term neurological sequelae.
Mechanisms and consequences of central nervous system hypoxia
2007, Neurobiology of Disease
Headache and sleep
2006, Sleep Medicine Reviews
Headache and sleep have long been recognised as being interdependent due to specific causative factors. Yet, the precise understanding of the roles played by these factors in this interdependency remains elusive. Many observations have suggested a reciprocal relationship between headache and sleep; however, these hypotheses have only been partially substantiated by robust findings. Being so, additional well-designed clinical and laboratory studies are required to confirm these relationships. Nonetheless, sleep and headache are known to be related in several ways: primary headache such as migraine, cluster headache (CH) and hypnic headache (HH) can be triggered by sleep, while chronic morning headaches can be caused by sleep disorders such as sleep apnoea and insomnia. Furthermore, headache and sleep disorders can also be symptoms of other underlying pathologies. Migraine, CH and HH seems to be related to sleep stages suggesting that they may in fact be a chronobiological disorder.
Patients suffering from chronic morning or nocturnal headache should be considered for the presence of possible sleep disturbances.
Mechanisms and consequences of central nervous system hypoxia
2006, Neurobiology of Disease
Classification of headache and facial pain
2003, Otolaryngologic Clinics of North America
PAP Adherence in Neurology Patients
2022, CPAP Adherence: Factors and Perspectives

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View full text

Review articleNeurologic Complications of Respiratory Disease

Section snippets

Respiratory Insufficiency

High-Altitude Sickness

Sleep Apnea Syndromes

Hyperventilation Syndrome

Summary

First page preview

Neurol Clin

Neurol Clin

Neurol Clin

Mayo Clin Proc

Neurologic manifestation of chronic pulmonary insufficiency

N Engl J Med

Sleep disorders

Marked papilloedema in pulmonary emphysema

Br J Ophthalmol

Neuropsychological effects of short-term discontinuation of oxygen therapyObservations in patients with chronic hypoxemia who are receiving long-term oxygen therapy

Arch Int Med

Neurologic aspects of hyperventilation syndrome

Semin Neurol

Sleep-related breathing disorders: 4—Consequences of sleep disordered breathing

Thorax

Economic and medical significance of sleep-related breathing disorders

Respiration

Cerebrospinal Fluid in Diseases of the Nervous System

Neurologic manifestations of respiratory disease

Sleep-related obstructive and nonobstructive apneas and neurologic disorders

Neurology

Fluid retention and hypoventilation in acute mountain sickness

Respiration

The cost to the central nervous system of climbing to extremely high altitude

N Engl J Med

Neurologic manifestations of respiratory failure

Arch Intern Med

Brief hypoxia-ischemia initially damages cerebral neurons

Arch Neurol

Review article
Neurologic Complications of Respiratory Disease