Central respiratory failure reversed by treatment. Brain 90,675-680[Free Full Text

RESPIRATORY failure in neurological disease is usually caused by respiratory muscle paralysis; common examples are polyneuritis, polio-myelitis and myasthenia. This report describes a patient with a cerebral tumour who had respiratory failure, shown by carbon dioxide retention, but who did not have respiratory muscle paralysis. His respiratory status was monitored by frequent estimations of mixed venous Pcoa. These measurements are easily performed by the house physician at the bedside without distress to the patient. There are three especial points of interest in this case. First, mixed venous Pco2 was a more sensitive index of respiratory status than minute volume, respiratory frequency or ventilatory capacity. Secondly, measurements of Pco2 showed that the patient's respiratory failure waxed and waned as his clinical state worsened and then improved after radio-therapy. Lastly, observations were made which suggest a possible mechanism of respiratory failure when the lungs are normal and respiratory muscles adequate. Case History.—J. C. Male. Age 18. Educationally subnormal. In August 1965 he was seen by his general practitioner because of diplopia and was noticed to have a right external rectus palsy. Four weeks later his speech became slurred and nasal in quality and he had difficulty in swallowing. On September 25th he was admitted to Hammersmith Hospital having had, in addition, a staggering gait and progressive cough for three days. He had had no sensory symptoms in the face or limbs. Examination.—Alert and co-operative. No papillcedema. Complete bilateral external rectus palsy. Coarse horizontal nystagmus on conjugate gaze to right and left and vertical nystagmus on conjugate upward gaze. Right masseter palsy. Gross bilateral facial palsy of lower motor neurone type. Palatal palsy. Pharyngeal anesthesia with absent gag reflex. Difficulty in swallowing and accumulation of secretions in pharynx. Weak tongue movements. Moderate right hemiparesis with hyper-reflexia and equivocal extensor plantar response. Cerebellar type ataxia in all four limbs. No sensory loss in the limbs. Sphincters functioned normally. Pulse irregular due to ventricular ectopic beats. Good equal chest expansion. Rhonchi in the lungs. by guest on