Central neurogenic hyperventilation: Pharmacologic intervention with morphine sulfate and correlative analysis of respiratory, sleep, and ocular motor dysfunction

K. A. Jaeckle, K. B. Digre, C. R. Jones, P. L. Bailey, P. C. McMahill

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Central neurogenic hyperventilation (CNH), for which there is no effective therapy, can eventually result in respiratory fatigue and death. This report describes a patient with CNH due to a brainstem anaplastic astrocytoma who also exhibited disturbances of sleep and ocular motor function. The CNH responded clinically to morphine sulfate and methadone. Analysis of ventilatory response to CO2 before and after morphine demonstrated a depression of ventilatory response (49 to 53% of baseline) and occlusion pressure response (35 to 50% of baseline) to CO2, with a requirement for high doses of naloxone (10 mg IV) to reverse the effect. Polysomnography revealed sustained hyperventilation, elevated O2 saturation, and low end-tidal CO2 throughout all stages of non-rapid eye movement (NREM) sleep, and absence of rapid eye movement (REM) sleep. Ocular motor evaluation disclosed absence of horizontal and reflexive saccades with compensatory head thrusts. Correlation of the clinical and physiologic data with the MRI abnormalities suggested that the lesion responsible for CNH in this patient might reside in the medial tegmental parapontine reticular formation. Since recurrent episodes of hyperventilation responded in a sustained fashion to IV and oral opiates, this treatment may warrant consideration in other patients with CNH.

Original languageEnglish (US)
Pages (from-to)1715-1720
Number of pages6
JournalNeurology
Volume40
Issue number11
StatePublished - Nov 1990
Externally publishedYes

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Hyperventilation
Morphine
Sleep
Opiate Alkaloids
Polysomnography
Saccades
Methadone
Astrocytoma
REM Sleep
Eye Movements
Naloxone
Respiratory Insufficiency
Brain Stem
Fatigue
Head
Pressure
Therapeutics

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Central neurogenic hyperventilation : Pharmacologic intervention with morphine sulfate and correlative analysis of respiratory, sleep, and ocular motor dysfunction. / Jaeckle, K. A.; Digre, K. B.; Jones, C. R.; Bailey, P. L.; McMahill, P. C.

In: Neurology, Vol. 40, No. 11, 11.1990, p. 1715-1720.

Research output: Contribution to journalArticle

Jaeckle, K. A. ; Digre, K. B. ; Jones, C. R. ; Bailey, P. L. ; McMahill, P. C. / Central neurogenic hyperventilation : Pharmacologic intervention with morphine sulfate and correlative analysis of respiratory, sleep, and ocular motor dysfunction. In: Neurology. 1990 ; Vol. 40, No. 11. pp. 1715-1720.
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