NEUROLOGY AND MEDICINE Respiratory aspects of neurological disease

Exertional dyspnoea is commonly an early feature in respiratory disease; however, neurological disease may limit mobility and, as a consequence, preclude this symptom. Diagnosis of respiratory dysfunction resulting from neurological disease may therefore require a higher index of clinical suspicion or the application of specific tests; this exercise is worthwhile if it allows advance detection and discussion and (where appropriate) treatment, of impending overt respiratory dysfunction. Specific symptoms and appropriate tests will be discussed in the text and have also been reviewed in detail elsewhere. However, it should be recalled that, at the most basic level, the function of the respiratory muscle pump is to produce inspiratory airflow, which is related to the ability to generate a subatmospheric pressure within the thorax. Thus, although access to detailed investigation of respiratory muscle is not universal, we encourage measurement of both the lying and standing vital capacity and static mouth/nasal pressures, 4 which can be done either in the neurological clinic or in any standard lung function laboratory. This review deals with acute neuromuscular respiratory disease (including those aspects of respiratory muscle function relevant to intensive care), chronic neuromuscular respiratory disease, sleep related disorders, respiratory consequences of neurological disease, and finally with neurological features of respiratory disease.