Abstract
A 61-year-old man who had been hypertensive for 10 years, was admitted to the National Cardiovascular Center, because of acute onset of tetraplegia and slight impairment of consciousness. He was diagnosed as wide-spread brain stem infarction with occlusion of the basilar artery, and his neurological manifestations are compatible with those of “locked-in syndrome”. During the course, Cheyne-Stokes respiration of a short cycle, of which period was within thirty seconds, and “sigh and rest” respiration were observed in the acute, and in both acute and chronic stage, respectively. “Sigh and rest” respiration was characterized by a single episodic deep inspiration followed by a respiratory arrest for 10 to 20 seconds during a regular respiration.
The pathogenesis and pathophysiology of these abnormal respirations were investigated by combinations of neurophysiological, neuro-otological and neuro-radiological examinations.
From the present study, it is suggested that Cheyne-Strokes respiration of a short cycle is caused by the extensive damage of bilateral basis and tegmentum of the pons including its lower level close to the medulla oblongata. Partial damage of the pontine tegmentum with extensive destruction of the basis pontis on both sides appears to cause “sigh and rest” respiration.
To recogniz the presence of these abnormal respiratory patterns provides an important information on the local diagnosis in the brain stem infarction.
