Respiratory failure and unilateral caudal brainstem infarction

J. Bogousslavsky, Ramesh Khurana, J. P. Deruaz, J. P. Hornung, F. Regli, R. Janzer, C. Perret

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Abstract

We report clinicotopographic correlations in 2 patients with central hypoventilation and unilateral infarct in the caudal brainstem. One patient had nearly complete loss of ventilation involving both automatic and voluntary components. He showed no ventilator response during a CO2 retention test (Paco2 62 mm Hg, Pao2 82 mm Hg), while consciousness was preserved until death. The infarct involved the reticular formation, nucleus tractus solitarius, nucleus ambiguus, and nucleus retroambiguus on the right but spared the dorsal motor nucleus of the tenth cranial nerve, and sensory and corticospinal tracts. The second patient showed hypoventilation more selectively involving automatic responses (Ondine's curse). The infarct involved the medullary reticular formation and nucleus ambiguus but spared the nucleus tractus solitarius. We suggest that unilateral involvement of pontomedullary reticular formation and nucleus ambiguus is sufficient for generating loss of automatic respiration, while associated lesion of the nucleus tractus solitarius may lead to more severe respiratory failure involving both automatic and voluntary responses.

Original languageEnglish (US)
Pages (from-to)668-673
Number of pages6
JournalAnnals of Neurology
Volume28
Issue number5
DOIs
Publication statusPublished - Jan 1 1990
Externally publishedYes

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ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Bogousslavsky, J., Khurana, R., Deruaz, J. P., Hornung, J. P., Regli, F., Janzer, R., & Perret, C. (1990). Respiratory failure and unilateral caudal brainstem infarction. Annals of Neurology, 28(5), 668-673. https://doi.org/10.1002/ana.410280511