June 1965

Respiratory Failure With Focal Neurological Signs

Author Affiliations


From the departments of medicine, Beth Israel Hospital and the Harvard Medical School. Senior Resident in Medicine (Dr. Pitt); Assistant Resident in Medicine (Dr. Sweet); Beth Israel Hospital. Research Fellow in Medicine, Harvard Medical School (Dr. Alkalay). Chief, Thoracic Clinic, Beth Israel Hospital, and Associate in Medicine, Harvard Medical School (Dr. Stein).

Arch Intern Med. 1965;115(6):714-717. doi:10.1001/archinte.1960.03860180086015

PAPILLEDEMA and generalized neurologic signs have been observed frequently in patients with respiratory failure.1-6 Textbooks of neurology, however, give only brief reference to generalized neurologic abnormalities in metabolic disorders and fail to mention the occurrence of focal neurologic signs in these disorders. The present report describes three patients with focal neurologic signs who illustrate the difficulties that may occur in differentiating the neurologic consequences of early respiratory failure from space occupying lesions of the brain.

Report of Cases 

Case 1.  —A 54-year-old woman was admitted to the Beth Israel Hospital on July 2, 1961, complaining of increasingly severe frontal headaches of three months' duration. The pain radiated from the front of her head to her left occiput and shoulder and occasionally disturbed her sleep. The pain usually lasted several hours. Three weeks prior to admission she developed blurred vision, vertigo, tinnitus, paresthesiae, and weakness of the fingers of the

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