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World J Crit Care Med. May 9, 2022; 11(3): 115-128
Published online May 9, 2022. doi: 10.5492/wjccm.v11.i3.115
Cough as a neurological sign: What a clinician should know
Mohammed Al-Biltagi, Adel Salah Bediwy, Nermin Kamal Saeed
Mohammed Al-Biltagi, Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
Mohammed Al-Biltagi, Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31512, Al Gharbia, Egypt
Mohammed Al-Biltagi, Department of Pediatrics, University Medical Center, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
Adel Salah Bediwy, Department of Chest Disease, Faculty of Medicine, Tanta University, Tanta 31512, Alghrabia, Egypt
Adel Salah Bediwy, Department of Chest Disease, University Medical Center, King Abdullah Medical City, Arabian Gulf University, Manama 26671, Bahrain
Adel Salah Bediwy, Department of Chest Diseases, University Medical Center, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
Nermin Kamal Saeed, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 26671, Bahrain
Nermin Kamal Saeed, Department of Pathology, Irish Royal College of Surgeon, Busaiteen 15503, Almuharraq, Bahrain
Author contributions: Al-Biltagi M, Bediwy AS, and Saeed NK did the research, collected the data, and wrote and revised the manuscript.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Al-Biltagi, MBChB, MD, MSc, Chairman, Professor, Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Building 61, King Abdelaziz Avenue, Manama 26671, Bahrain. mbelrem@hotmail.com
Received: October 11, 2021
Peer-review started: October 11, 2021
First decision: March 24, 2022
Revised: March 24, 2022
Accepted: April 26, 2022
Article in press: April 26, 2022
Published online: May 9, 2022
Processing time: 207 Days and 15.4 Hours
Abstract

Cough is a common respiratory complaint driving patients to seek medical advice. Besides being a fundamental respiratory sign, it is also a crucial neurological sign. There are three main types of coughs: Reflex cough (type I), voluntary cough (type II), and evoked cough (type III). Cough is a reflex predominantly mediated by control centers in the respiratory areas of the brainstem, modulated by the cerebral cortex. Cough reflex sensitivity could be increased in many neurological disorders such as brainstem space-occupying lesions, medullary lesions secondary to Chiari type I malformations, tics disorders such as Tourette's syndrome, somatic cough, cerebellar neurodegenerative diseases, and chronic vagal neuropathy due to allergic and non-allergic conditions. Meanwhile, cough sensitivity decreases in multiple sclerosis, brain hypoxia, cerebral hemispheric stroke with a brainstem shock, Parkinson's disease, dementia due to Lewy body disease, amyotrophic lateral sclerosis, and peripheral neuropathy as diabetic neuropathy, hereditary sensory and autonomic neuropathy type IV, vitamin B12, and folate deficiency. Arnold's nerve ear-cough reflex, syncopal cough, cough headache, opioids-associated cough, and cough-anal reflex are signs that could help diagnose underlying neurological conditions. Cough reflex testing is a quick, easy, and cheap test performed during the cranial nerve examination. In this article, we reviewed the role of cough in various neurological disorders that increase or decrease cough sensitivity.

Keywords: Cough reflex; Neurological disorders; Cerebral disorders; Cerebellar disorder; Vagal neuropathy; Parkinsonism

Core Tip: The article aimed to define the role of cough as a crucial symptom and sign for various neurological disorders. It sheds some light on the cough reflex and when its sensitivity is exaggerated or depressed and related to multiple neurological diseases. Cough reflexes can help diagnose some acute and chronic neurologic disorders, both in children and adults.