An Uncommon Case of Brainstem Tumor With Selective Involvement of the Respiratory Centers

doi:10.1378/chest.103.6.1909

Chest

Volume 103, Issue 6, June 1993, Pages 1909-1910

https://doi.org/10.1378/chest.103.6.1909 Get rights and content

We report a clinical case of a young man with a brainstem tumor with a stable alveolar hypoventilation syndrome as the only symptom of the disease. The ventilatory response to CO₂ was almost absent and the ventilatory pattern during tidal breathing was very irregular. The diagnosis was made by magnetic resonance imaging of the brain and confirmed by a stereotactic brain biopsy specimen.

(Chest 1993; 103:1909-10)

Section snippets

CASE REPORT

A 24-year-old white man with β-thalassemia minor was referred to our examination for evaluation of respiratory failure, hypertension, and erythrocytosis. The patient complained of sleep disorders (restlessness, sudden awakenings, enuresis) and diurnal sleepiness that impaired working efficiency and interpersonal relationships. On physical examination we found the following: mild cyanosis; irregular respiratory rate and continuously changing tidal volume; systolic murmur at the apex and at the

DISCUSSION

The tumor probably started some years before the appearance of a clear clinical picture. The initial functional effect was a sleep apnea syndrome that escaped detection for a long time. Owing to the slow evolution of the neoplasm, the control of breathing was probably modified first during sleep, then also during wakefulness, leading to a stable alveolar hypoventilation.

The hypoxia, due to the hypoventilation, increased the erythropoiesis. However, this patient had a normal value of hemoglobin

REFERENCES (4)

AJ Moore
Brain tumors: what are the general and focal effects?
Postgrad Med
(1988)
F Hochberg et al.
Neoplastic diseases of the central nervous system

There are more references available in the full text version of this article.

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Furthermore, respiratory disturbances (including CSA) were also associated with cavernous malformation, osmotic demyelination syndrome, multiple sclerosis, Leigh syndrome, heterotopia of the inferior olive, mitochondrial and degenerative disease (eg, multisystem atrophy) [4,43–46]. Primary brainstem tumors, particularly gangliogliomas, have also been cited as a cause of Ondine syndrome [46–48]. Postoperative complications resulting in CSA were described after high cervical chordotomy for cancer pain [49], microsurgery for brainstem tumors such as meningioma with clear cells [50], and hemangioblastoma [41].
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Clinically observed complications of surgical resection of these tumors include motor, cognitive, and ocular morbidities (Cochrane et al., 1994). Respiratory disturbances, including apnea and sleep disordered breathing (SDB), have been canonically associated with brainstem dysfunction (from primary tumor burden or post-operative complications) (Ito et al., 1996; Manning and Leiter, 2000; Osanai et al., 1994; Valente et al., 1993), but SDB is not as systematically described in those with abnormalities limited to the cerebellum. Illustrative reports of those with SDB subsequent to posterior fossa surgery and associated with primary cerebellar abnormalities lend strength to the cerebellum's role in respiratory control (Adelman et al., 1984; Chokroverty et al., 1984; Cochrane et al., 1994; Losurdo et al., 2013; Wolfe et al., 2010).
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Chest

Selected ReportsAn Uncommon Case of Brainstem Tumor With Selective Involvement of the Respiratory Centers

Section snippets

CASE REPORT

DISCUSSION

Brain tumors: what are the general and focal effects?

Postgrad Med

Neoplastic diseases of the central nervous system

Selected Reports
An Uncommon Case of Brainstem Tumor With Selective Involvement of the Respiratory Centers