Abstract
In 48 patients with cerebrovascular diseases, spontaneous breathing patterns were recorded using the impedance or thermister pneumographic technique to investigate the incidence of abnormal respiration and its relation to localization of the lesion in the brain.
It was only in 8 cases that any abnormal breathing pattern could not be detected.
Twenty-seven patients had supratentorial lesions either unilateral (9 cases) or bilateral (18 cases). The only abnormal pattern obtained in this group was the periodic breathing including Cheyne-Stokes respiration, which was particularly common (80%) in those with bilateral lesions.
In 10 cases of midbrain involvements mainly due to cerebral herniation, tachypnea with respiratory alkalosis was characteristic and its incidence was up to 70%. Periodic breathing also co-existed in 2 cases.
When the pons was involved, various abnormal breathings appeared : Of 13 patients with pontine damages, so-called cluster respiration was observed in 3, Cheyne-Stokes respiration in 4, and tachypnea in 3, respectively. In 4 of 5 cases of basilar artery occlusion with bilateral widespread brainstem lesions which were mainly distributed in the pontine basis, “sigh-and-rest” respiration was observed. The “sigh-and-rest” respiration was characterized by a single episodic deep inspiration followed by a respiratory arrest for 10 to 20 seconds during regular respiration. Other abnormal respiratory patterns such as periodic breathing (2 cases), tachypnea (2 cases) and cluster respiration (1 case) were also seen in those patients.
Medullary damages by tonsillar herniation occurred in 11 cases and ataxic respiration was observed in all of them prior to terminal respiratory arrests.
There observed two types of Cheyne-Stokes respiration : One is that with a long cycle in which a single periodic time ranged from 60 to 120 seconds with an average of 62 seconds. This type of Cheyne-Stokes respiration was attributed to supratentorial lesions and the mortality rate with this pattern was relatively low (25%). The other is the Cheyne-Stokes respiration with an average of 27 seconds. This type of Cheyne-Stokes respiration was caused by brainstem lesions and its occurrence related to a high mortality rate (100%).
From these findings, it is suggested that observations of respiratory patterns provide a significant value for local diagnosis of brain damages in those with cerebrovascular diseases.
