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Forensic Pathophysiology of Asphyxial Death
Published in Sudhir K. Gupta, Forensic Pathology of Asphyxial Deaths, 2022
Medulla and pons contain the central respiratory centers that are responsible for initiating, controlling and maintaining the respiratory pattern. The medullary center consists of a dorsal and a ventral respiratory group, and the pontine center consists of a pneumotaxic center and an apneustic center together forming the pontine respiratory group. The dorsal respiratory neurons initiate the process of inspiration and the ventral group controls expiration. The pneumotaxic center and the apneustic center provide negative and positive feedback to the dorsal respiratory group, respectively, thereby regulating the discharges from this center (Figure 1.5).
Chronic Fatigue Syndrome: Limbic Encephalopathy in a Dysregulated Neuroimmune Network
Published in Jay A. Goldstein, Chronic Fatigue Syndromes, 2020
The central nuclei of the amygdala have a massive projection to the pneumotaxic center in the pons. Single pulse stimulation of these amygdalar nuclei in monkeys causes an immediate switch to inspiration.83 I can think of no other single reason to explain the respiratory abnormalities that we see in CFS other than this sort of amygdalar dysfunction. The limbic system has been shown to regulate automatic, but not voluntary, respiration.84
Organization of Central Respiratory Neurons
Published in Alan D. Miller, Armand L. Bianchi, Beverly P. Bishop, Neural Control of the Respiratory Muscles, 2019
Armand L. Bianchi, Rosario Pásaro
Several electrophysiological studies have reported the presence of numerous respiratory-related neurons in the rostral pons, namely in the nucleus parabrachialis medialis (NPBM) and Kölliker-Fuse (KF) nucleus. These regions are now often designated as the pontine respiratory group (PRG)30 (Figure 3B). The PRG was previously considered the site of the “pneumotaxic center” controlling inspiratory duration.18 Most neurons of the PRG fire toni-cally, with peak frequencies occurring in inspiration, expiration, or at the transitions between respiratory phases (phase-spanning neurons).
Chameleons, red herrings, and false localizing signs in neurocritical care
Published in British Journal of Neurosurgery, 2022
Boyi Li, Tolga Sursal, Christian Bowers, Chad Cole, Chirag Gandhi, Meic Schmidt, Stephan Mayer, Fawaz Al-Mufti
Central neurogenic hyperventilation, a syndrome in which hyperpnea and associated respiratory alkalosis occur during both wakefulness and sleep, is considered a result of a pontine lesion, most commonly secondary to tumors.80,85 The exact pathophysiology beyond stimulation of respiratory control areas in the pons and medulla remains unclear.85 When this syndrome is suspected based on clinical presentation, other causes of hyperventilation, such as pulmonary embolus or respiratory disease, must first be ruled out.80 Lesions to the caudal respiratory neurons can cause an apneustic breathing pattern in which each inspiration is accompanied by a prolonged pause.80 As a FLS, this syndrome can also be caused by lower lesions. There have been five reported cases of such apneustic breathing in patients with achondroplasia, the pathophysiology being cervicomedullary compression rather than vagal or pneumotaxic center lesions.86 The lesion’s severity, location, and reversibility by decompression is variable.86 Central neurogenic hyperventilation can also result from thalamic lesions.85 Diagnosis involves polysomnography sleep studies, measuring somatosensory evoked potentials, and CT and MRI scans of the brain.85,86