Effects of ischemic phrenic nerve root ganglion injury on respiratory disturbances in subarachnoid hemorrhage: an experimental study.
BACKGROUND
Phrenic nerves have important roles on the management of respiration rhythm. Diaphragm paralysis is possible in phrenic nerve roots ischemia in subarachnoid hemorrhage (SAH). We examined whether there is a relationship between phrenic nerve root ischemia and respiratory disturbances in SAH.


METHODS
This study was conducted on 5 healthy control and 14 rabbits with experimentally induced SAH by injecting autologous blood into their cisterna magna. Animals were followed up via monitors for detecting the heart and respiration rhythms for 20 days and then decapitaed by humanely. Normal and degenerated neuron densities of phrenic nerve root at the level of C4 dorsal root ganglia (C4DRG) were estimated by Stereological methods. Between the mean numerical density of degenerated neurons of C4DRG and respiratory rate/minute of groups were compared statistically.


RESULTS
Phrenic nerve roots, artery and diaphragm muscles degeneration was detected in respiratory arrest developed animals. The mean neuronal density of C4DRG was 13272 ±1201/mm3 with a mean respiration rate of 23 ±4/min in the control group. The mean degenerated neuron density was 2.240 ±450/mm(3) and respiration rhythm was 31 ±6/min in survivors. But, the mean degenerated neuron density was 5850 ±650/mm(3) and mean respiration rhythm was 34 ±7/min in respiratory arrest developed animals (n = 7). A linear relationship was noticed between the degenerated neuron density of C4DRG and respiraton rate (r = -0.758; p < 0.001).


CONCLUSIONS
Phrenic nerve root ischemia may be an important factor in respiration rhythms deteriorations in SAH which has not been mentioned in the literature.
Department of Neurology, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
Hızır
H
Ulvi
Department of Neurology, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
Recep
R
Demir
Department of Neurology, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
Recep
R
Aygül
Department of Neurology, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
Dilcan
D
Kotan
Department of Pathology, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
Muhammet
M
Calik
Department of Neurosurgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
Mehmet Dumlu
MD
Aydin
C4 dorsal root ganglia; phrenic nerve; respiration; subarachnoid hemorrhage