Cardiovascular and respiratory consequences of bilateral involvement of the medullary intermediate reticular formation in syringobulbia

We studied five patients with clinical and radiological evidence of syringobulbia (SB) to determine whether the distribution of lesions in relationship to the cardiorespiratory control networks in the medullary intermediate reticular zone (IRt) correlates with the presence of abnormalities in autono...

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Bibliographic Details
Published in:	Clinical autonomic research Vol. 12; no. 6; pp. 450 - 456
Main Authors:	Heidel, K M, Benarroch, E E, Gené, R, Klein, F, Meli, F, Saadia, D, Nogués, M A
Format:	Journal Article
Language:	English
Published:	Germany Springer Nature B.V 01-12-2002
Subjects:	Adult Autonomic Nervous System - physiopathology Cardiovascular System - physiopathology Female Humans Magnetic Resonance Imaging Male Medulla Oblongata - pathology Middle Aged Polysomnography Respiratory System - physiopathology Reticular Formation - physiopathology Sleep Apnea Syndromes - etiology Sleep Apnea Syndromes - physiopathology Syringomyelia - complications Syringomyelia - diagnosis Syringomyelia - physiopathology
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Summary:	We studied five patients with clinical and radiological evidence of syringobulbia (SB) to determine whether the distribution of lesions in relationship to the cardiorespiratory control networks in the medullary intermediate reticular zone (IRt) correlates with the presence of abnormalities in autonomic cardiovascular and respiratory control in these patients. All patients underwent high resolution MRI to characterize the size, volume and distribution of the SB lesions, cardiovascular autonomic function testing and polysomnography. One patient with bilateral IRt involvement at both the rostral and caudal medulla had orthostatic hypotension (OH), absent HR(DB), abnormal Valsalva ratio, exaggerated fall of BP during phase II and absent phase IV during VM, and a dramatic fall of BP during head up tilt; this patient also had severe obstructive sleep apnea (OSA) and exhibited BP drops during each respiratory effort. A second patient, with bilateral IRt involvement restricted to the caudal medulla, had less severe cardiovascular autonomic dysfunction but also exhibited severe OSA. The other three patients had small SB cavities sparing the IRt and had sleep apnea but no autonomic dysfunction. Autonomic dysfunction could not be related to the size of the syrinx or the degree of atrophy in the cervical spinal cord in any of the five patients. Bilateral involvement of the IRt by SB produces cardiovascular autonomic failure and sleep apnea. In patients with more restricted lesions, autonomic and respiratory dysfunction may be dissociated. Clinico-radiological correlations using high resolution MRI assessment of medullary lesions can provide insight into the central organization of cardiovascular and respiratory control in humans.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0959-9851 1619-1560
DOI:	10.1007/s10286-002-0075-1