title: [Acute respiratory insufficiency as initial manifestation of brain stem lesions].
abstract: We describe three patients with different brainstem lesions (bulbar angioma, bulbar infarct, and Arnold-Chiari malformation) who debuted with acute respiratory insufficiency. Other neurological manifestations had gone unobserved in all three cases. Respiratory insufficiency worsened notably during sleep to the point that mechanical ventilation was required or death occurred (Ondine s curse). The patient with a bulbar angioma is stable with only assisted ventilation by a nasal route at night, with good quality of life. Our conclusions are that: a) central nervous system anomalies need to be investigated as possible causes of respiratory insufficiency when lungs are normal; b) the respiratory control of patients with brainstem lesions should be studied, particularly at night (polysomnography), and c) even when awake-state ventilation is adequate, nighttime assisted ventilation may be required.
authors.affiliation: Servicio de Neumología, Hospital General Universitario, Valencia.
authors.forename: G
authors.initials: G
authors.lastname: Juan
authors.forename: M
authors.initials: M
authors.lastname: Ramón
authors.forename: M A
authors.initials: MA
authors.lastname: Ciscar
authors.forename: B
authors.initials: B
authors.lastname: García
authors.forename: T
authors.initials: T
authors.lastname: Lloret
authors.forename: M A
authors.initials: MA
authors.lastname: Cervelló
authors.forename: J
authors.initials: J
authors.lastname: Marín
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001139:Arnold-Chiari Malformation / Q000175:diagnosis*; D020526:Brain Stem Infarctions / Q000175:diagnosis*; D020295:Brain Stem Neoplasms / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006392:Hemangioma, Cavernous / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D017286:Polysomnography; D011788:Quality of Life; D016634:Radiosurgery; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology*; D020182:Sleep Apnea, Central / Q000175:diagnosis / Q000209:etiology / Q000628:therapy