Talk:Central neurogenic hyperventilation

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Talk: Central neurogenic hyperventilation In the text " CNH is the human body's response to reduced carbon dioxide levels in the blood. " What's the possible mechanism? The CO2 is an stimulant of the breathing and de dimnution of its level dont would accelerate the rate. Tanks for the article.

Comment 1

After doing some research on this interesting topic I came across an article that discusses another cause of CNH in detail. The article is titled "Central neurogenic hyperventilation in an awake patient with a pontine glioma" and is authored by Siderowf AD, Balcer LJ, Kenyon LC, Nei M, Raps EC, and Galetta SL. The article describes a structural mechanism for CNH. It explains how the combination of alkaline CSF (cerebrospinal fluid) and an infiltrating pontine lesion can raise serum pH as high as 7.72. This in turn, leads to CNH. I believe this article can greatly expand your "Causes of CNH" section with another important mechanism that can induce CNH. Giantsjs2000 (talk) 01:04, 24 November 2009 (UTC)

Thanks for the information. We will expand the article accordingly. neurosoltisk (talk) 10:19, 27 November 2009 (UTC)

Comment 2

Hey guys, great job on the article! I don't know if you guys had trouble looking for sources for your project like we did, but one thing that helped us was requesting sources through the library. Some articles are not fully available online, but if you fill out a request form through the library, BC will actually get access to the article and they email you the pdf version. It's a great way to get additional sources that are not easily available. It takes about 1 to 2 days for them to send you the article chengkd (talk) 7:53, 29 November 2009 (UTC)

Hey, thanks for the advice! We were running into that problem pretty frequently. I will get in touch with the library and see if they can get access to additional articles for us. neurosoltisk (talk) 18:53, 29 November 2009 (UTC)

Comments 3 and 4

The article is informative and well written. In the "Current and Future Research" section, it's stated that not much information has been collected on how to treat the illness. I found an article that may give some insight into the treatment of the disease. http://www.neurology.org/cgi/content/abstract/40/11/1715 It discusses how the administration of morphine sulfate and methadone may depress ventilatory response as a result of CNH. Why is that? KrystalMarquis (talk) 03:47, 29 November 2009 (UTC)

We've changed the article to briefly discuss how morphine depresses ventilation. However, we do not feel much more information should be added because it would stray in relevancy from the article. Please feel free to reference the morphine link on our page for more information on its effects.nalvarez (talk) neurosoltisk(talk)09:30, 07 December 2009 (UTC) —Preceding unsigned comment added by 136.167.66.29 (talk)

I found an article that may provide additional information on methods for treating CNH. However, I was unable to gain access to the article. I requested an interlibrary loan/ document delivery and will let you know when I receive it. The ISSN is:0340-5354. The title of the article is Treatment of central neurogenic hyperventilation with plasma exchange. Patrick Raab 06:37, 29 November 2009 (UTC) —Preceding unsigned comment added by Patrick.Raab.1 (talk • contribs)

Thanks for the additional information! Though we did briefly mention in the treatment section that morphine was used to treat CNH through depression of ventilatory response, I do agree that we can further elaborate on how/why the treatment works. Patrick, thanks for going above and beyond and requesting that article through interlibrary loan. Due to the rarity of the disorder we struggled with finding articles and did not think of using the library and its resources. Any further information on the article you found would be great. We mentioned briefly that plasma exchange was used in the case of non-tumor induced CNH and I would be interested in finding out more information on this course of treatment. Naweston (talk) 19:45, 5 December 2009 (UTC)

Comment 5

Great article! It is very informative, especially with the limited resources due to the rarity of the disease, which makes understanding the disease much more difficult. The use of a graphic or diagram may be beneficial in explaining the disease. marissa.hone 29 November 2009 —Preceding undated comment added 17:10, 29 November 2009 (UTC).

Thanks for the suggestion. We struggled a bit in finding images that were available due to copyright, but we will continue to search. Naweston (talk) 17:58, 29 November 2009 (UTC)

Update- I have added a picture of the pons/medulla, the area of the brain that controls main respiratory functioning and whose pathophysiology is implicated as one of the main causes of CNH. I hope it helps and will continue to search for pictures that may enhance understanding. Unfortunately, due to the disease's rarity, there aren't many available resources to show specific cases of tumors that induced CNH. Naweston (talk) 19:45, 5 December 2009 (UTC)

In addition, we have included a secondary picture of a pons, medulla oblongata, and cerebellum cross-section to give another view of this area. We have also incorporated an animation to demonstrate how an MRI would elucidate lesion areas. Neurosoltisk (talk) nalvarez(talk) 09:36, 7 December 2009 (UTC) —Preceding unsigned comment added by 136.167.66.29 (talk)

Comment 6

Overall, I found your article to be very informative. I especially respect the detailed manner in which you explain the causes of CNH, taking care to address all facets of the condition while highlighting the inconclusiveness due to insufficient case study. My only suggestions concern points of clarity with respect to psychology of CNH:

In the ADDITIONAL FINDINGS section, it is stated that: “Although the majority of CNH-inducing tumors are located in close proximity to other medullary homeostatic centers, the psychological changes associated with CNH are restricted to alterations in the control of breathing.” While the inability to voluntarily control breathing is explained later in the SYMPTOMS section, the PROGNOSIS section cites altered mood, mental state, inattentiveness, an anxiety as effects of CNH. Therefore, I think it would be helpful to reword and/or reorder some of this information such that it is more cohesive and a bit less contradictory. (I’m sorry if this critique seems a bit pointed, but you did such a great job with the article in general that I figured I’d focus on something small!) Below you'll find a web address that might be useful to you; the study defines certain psychiatric effects of the CNH.

Respiratory and Psychiatric Abnormalities in Chronic Symptomatic Hyperventilation

Additionally, I thought I’d point out that there is a type-o in the ADDITIONAL FINDINGS section: “…and only 21 cases additional cases…”

Hope this helps! Haworthk (talk) 18:08, 29 November 2009 (UTC)

Hey, thanks for the heads up! I have made the corrections as requested to make the article more coherent.neurosoltisk (talk) 02:58, 29 November 2009 (UTC)

Hi, I researched the article that you provided and while it does discuss psychiatric abnormalities associated with chronic symptomatic hyperventilation, it does not really apply to our specific topic of central neurogenic hyperventilation, which is usually caused by tumors and has not yet been associated with psychiatric or respiratory abnormalities. It is important to make the distinction between CNH and other forms of hyperventilation, as CNH is rare due to its non-association with any emotional or psychological causes. Also, your comment made me recognize an important typo that was made. The sentence was supposed to be discussing physiological, not psychological, effects of the disease. Before this error was corrected, the sentence was indeed contradictory to the symptoms listed under the Symptoms and Prognosis sections, so thank you again for pointing that out. Naweston (talk) 19:45, 5 December 2009 (UTC)

Comment 7

Good article overall! “Subsequent findings revealed CNH can also occur in conscious patients.” This didn’t make sense to me at first, as the next sentence talks about tumor induced CNH. After reading some of your cited papers, it makes a bit more sense. However, you note in the “Diagnosis” section that CNH must occur in both awake and sleeping states to be diagnosed, but later say that it can occur in both states. I just thought that could use some clarification because it’s not completely clear at first what the relationship is between conscious, unconscious, tumor induced and non-tumor induced CNH is. Additionally, the symptoms are gone over in a couple of sections, as well as information on the relationship between tumors and CNH.

Also, I found an article talking about a case study using morphine sulphate and methadone to treat CNH, as there appears to be a dearth of articles on treatment I thought you might find it helpful (http://www.ncbi.nlm.nih.gov/pubmed/2234427?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=26) Again, great job! Good luck with your revisions, I hope this helps.Philipthegreat88 (talk) 01:19, 30 November 2009 (UTC)

Hi. CNH was intially diagnosed by Plum and Swanson only in comatose (unconscious) patients. It was originally thought that this condition was restricted to unconscious patients, but later it was discovered that, though very rare, CNH does occur in patients that are not comatose (conscious). Tumors have been cited as the cause of CNH in both cases (conscious and unconscious). Non-tumor induced CNH is very rare, and has only been diagnosed once. We discussed that it occurred in an MS patient and was treated accordingly. In regards to sleeping, though temporarily unconscious, patients are still considered to be in a conscious, non-comatose state. It is important for CNH to persist through sleep for a positive diagnosis to be made, especially to rule out any emotional or psychiatric causes of the hyperventilation that would NOT persist during sleep. Hope that helps. We will take these suggestions into account when trying to clarify/edit the sections of the paper and I will research the treatment with morphine further, though it was already mentioned briefly in our Treatments section. Naweston (talk) 19:45, 5 December 2009 (UTC)

Comment 8

I thought your intro did a great job giving the quick visitor just enough information to feel like they know what the subject is without having to digest a great amount of detail about the subject. That being said, I would reword the last sentence in the introduction. To me, "CNH remains an underdeveloped area of medicine that needs to be explored" seems a bit awkward. Perhaps something like "Due to its rarity and the rate at which patients deteriorate, CNH is difficult to research and is not yet fully understood. A great deal more effort needs to be invested before cures and treatments become a reality." Just a suggestion, but otherwise, great work. Aceintheh0l3 (talk) 01:29, 30 November 2009 (UTC)

Thanks for the suggestion. We were already considering modifying the introduction a bit and I will definitely take your comment into account when doing so. Nalvarez (talk) —Preceding undated comment added 02:45, 1 December 2009 (UTC).

Comment 9

Great job with researching this rare condition! The article contains great information, and in my opinion also flows very well. I have looked through the previous comments and don’t believe that anyone pointed out a small typo in the introduction paragraph. I believe you meant to say carbon dioxide where it reads “this reduction in carbion dioxide”. Also, I found another article that may be of interest in discussing the pathophysiology of CNH. It discusses the resulting hyperventilation of a 40 year old woman presenting with persistent severe hypocapnia and alkalemia in a 40-year old woman. Here is the link: http://chestjournal.chestpubs.org/content/118/1/242.full . Due to the discussion of a lack of resources, I thought another case study of a patient with CNH might be able to enhance your article a bit more. Good luck and great researching and writing! aryberg89 (aryberg89) 22:05, 30 November 2009

Thank you for the article. We incorporated the information into our Treatment and Causes sections. Naweston (talk) 20:20, 5 December 2009 (UTC)