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Respiratory failure and unilateral caudal brainstem infarction
Author(s) -
Bogousslavsky J.,
Khurana R.,
Deruaz J. P.,
Hornung J. P.,
Regli F.,
Janzer R.,
Perret C.
Publication year - 1990
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.410280511
Subject(s) - nucleus ambiguus , brainstem , medicine , reticular formation , medulla oblongata , anesthesia , hypoventilation , nucleus , anatomy , neuroscience , respiratory system , central nervous system , biology , psychiatry
We report clinicotopographic correlations in 2 patients with central hypoventilation and unilateral infarct in the caudal brainstem. One patient had nearly complete loss of ventilation involving both automatic and voluntary components. He showed no ventilator response during a CO 2 retention test (Paco 2 62 mm Hg, Pao 2 82 mm Hg), while consciousness was preserved until death. The infarct involved the reticular formation, nucleus tractus solitarius, nucleus ambiguus, and nucleus retroambiguus on the right but spared the dorsal motor nucleus of the tenth cranial nerve, and sensory and corticospinal tracts. The second patient showed hypoventilation more selectively involving automatic responses (Ondine's curse). The infarct involved the medullary reticular formation and nucleus ambiguus but spared the nucleus tractus solitarius. We suggest that unilateral involvement of pontomedullary reticular formation and nucleus ambiguus is sufficient for generating loss of automatic respiration, while associated lesion of the nucleus tractus solitarius may lead to more severe respiratory failure involving both automatic and voluntary responses.