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Central hypoventilation as the presenting symptom in Hu associated paraneoplastic encephalomyelitis
  1. Manuel J Gómez-Choco1,
  2. Juan J Zarranz2,
  3. Albert Saiz3,
  4. María I Forcadas2,
  5. Francesc Graus3
  1. 1
    Hospital Clinic, Service of Neurology, Barcelona, Spain
  2. 2
    Hospital Cruces, Service of Neurology, Bilbao, Spain
  3. 3
    Hospital Clinic, Service of Neurology, Barcelona, Spain
  1. Dr Manuel J Gómez-Choco, Hospital Clinic, Service of Neurology, Villarroel 170, Barcelona 08036, Spain; gomezchoco{at}


Central hypoventilation is usually caused by ischaemic or neoplastic lesions of the medulla and upper cervical spinal cord. An autoimmune disorder is not usually considered in the differential diagnosis of this syndrome. We retrospectively identified 14 patients from our database of 202 patients with Hu antibodies who presented with brainstem symptoms. Three were admitted to hospital because of central hypoventilation. All underwent intubation and mechanical ventilation. They could breathe properly while they were awake but suffered deep apnoeas during sleep. Two died, but one is still alive requiring ventilatory assistance during sleep. Autopsy was performed in one of the patients which showed severe inflammatory infiltrates and neuronal loss in the medulla. All patients had normal brain imaging studies and the cause of central hypoventilation was an unsolved problem until Hu antibodies were determined.

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  • Competing interests: None.

  • Informed consent was obtained from one of the patients. The other two patients had died years before and it was not possible to contact their relatives.

  • Abbreviations:
    Hu antibodies