Profound pulmonary shunting without edema following stereotaxic biopsy of hypothalamic germinoma. Case report.
Hypoxemia is a nearly constant accompaniment of head injury. Diverse theories have been proposed to explain this relationship. The authors report the case of a patient who suffered an episode of severe, transient, arterial oxygen desaturation during "controlled" brain trauma: an otherwise uneventful stereotaxic biopsy of a small germinoma of the hypothalamus. Evidence is provided that pure ventilation-perfusion mismatching, without pulmonary edema, underlay the hypoxemia. The hypothalamus is intimately involved in matching pulmonary ventilation to perfusion; the hypoxemia of various brain injuries may be mediated by perturbation of this structure.
Epstein
F M
FM
Division of Neurosurgery, Medical College of Virginia, Virginia Commonwealth University, Richmond.
Cooper
K R
KR
Ward
J D
JD
D000293:Adolescent; D001706:Biopsy / Q000009:adverse effects*; D001930:Brain Injuries / Q000503:physiopathology; D004407:Dysgerminoma / Q000473:pathology*; D006801:Humans; D007029:Hypothalamic Neoplasms / Q000473:pathology*; D000860:Hypoxia / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D011654:Pulmonary Edema / Q000209:etiology* / Q000503:physiopathology; D013238:Stereotaxic Techniques / Q000009:adverse effects*; D014692:Ventilation-Perfusion Ratio