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Fred Plum, MD
Department of Neurology and Neuroscience The New York Hospital—Cornell Medical Center 525 E 68th St New York, NY 10021

Arch Neurol. 1992;49(5):441.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—Munschauer et al¹ describe an interesting example of a man with a magnetic resonance image that demonstrated paramedian ventral pontine damage. He breathed normally at rest and in response to carbon dioxide stimulation, but he was unable to initiate either breathing or swallowing by voluntary effort. Recent, indirect, physiologic studies employing functional activation of cerebral blood flow² indicate that at least the diaphragm enjoys direct representation in the cerebral motor cortex, premotor cortex, supplementary motor area, and cerebellum. The results of transcranial magnetic stimulation³ confirm the finding and suggest that considerable lateralization exists in cerebral diaphragmatic control since unilateral stimulation over motor-premotor cortex from either hemisphere evokes predominantly contralateral diaphragmatic movement in a manner similar to that observed with voluntary acts of the limbs. Evidently, this higher, cerebral regulation of respiratory striated muscle subserves the major behavioral functions of the system.

Munschauer et al, . . . [Full Text PDF of this Article]

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