title: Ondine's curse in association with diabetes insipidus following transient vertebrobasilar ischemia.
abstract: Ischemic lesions of the brainstem can lead to complex neurologic deficits. Failure of the automatic control of ventilation (Ondine's curse syndrome) is a possible but rare syndrome following localized brainstem dysfunction. We report on a 49-year-old man with intermittent bradycardia, cranial nerves' dysfunctions and a slight right-sided hemiparesis. An acute brainstem ischemia was diagnosed and treated immediately with high-dose heparin. Cerebral angiography revealed a proximal occlusion of the left vertebral artery but a normal right vertebral artery and a hyperplastic right posterior inferior cerebellar artery. Cranial Computed Tomography and MRI scan demonstrated multiple ischemic lesions in the posterior circulation. During a 4-week treatment course the patient underwent six episodes of acute severe hypoxia and hypercapnia requiring orotracheal intubation twice and manual ventilation by air mask over a few minutes for four times after a tracheostomy had been performed. Twice a short-term episode of hypothalamic Diabetes insipidus was observed following hypoventilation. We conclude that both Ondine's curse syndrome and diabetes insipidus were due to transient vertebrobasilar ischemia.
authors.affiliation: Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Kraus
authors.forename: J G
authors.initials: JG
authors.lastname: Heckmann
authors.forename: A
authors.initials: A
authors.lastname: Druschky
authors.forename: F
authors.initials: F
authors.lastname: Erbguth
authors.forename: B
authors.initials: B
authors.lastname: Neundorfer
mesh_terms: D020526:Brain Stem Infarctions / Q000150:complications* / Q000175:diagnosis; D002533:Cerebral Angiography; D003919:Diabetes Insipidus / Q000209:etiology*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D020182:Sleep Apnea, Central / Q000209:etiology*; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000473:pathology; D014715:Vertebrobasilar Insufficiency / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy