Central nervous system causes

Diseases of the nervous system can cause respiratory failure by damaging the respiratory centre in the medulla or its connections with the cervical and thoracic spinal cord (Box 11.1). In practice the commonest causes are the secondary consequences of CNS depression by drugs, metabolic abnormalities, or primary cerebral or brain stem disease. These are important in differential diagnosis but this review is confined to disorders affecting the lower motor neuron, peripheral nerves, neuromuscular junction, and muscles. The localisation of the disease process to the brain stem or spinal cord does not usually present the neurologist with any difficulty because of the presence of symptoms and signs at the level of the lesion and involvement of the long tracts.

Wild type poliomyelitis remains a common problem in the Indian subcontinent and south east Asia. Rare vaccine-associated cases still occur throughout the world. Poliomyelitis should still be considered in the differential diagnosis of acute flaccid paralysis when sensory deficit is absent, the onset is asymmetrical, and the CSF shows a pleocytosis especially in recent vaccine recipients or their contacts.7,8 Enteroviruses other than polio and flaviviruses which cause tick-borne encephalitis can also produce a poliomyelitis-like illness.9 The diagnosis of polio may be confirmed by culturing the stool, and sometimes a throat swab or CSF, and by finding a rising titre of neutralising antibody in the serum.

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