Takehara M, Ishikawa K, Hiroi T, Fujimura H, Yorifuji S
Department of Internal Medicine, Kure National Hospital.
Rinsho Shinkeigaku. 1992 May;32(5):511-5.
We reported here a 64-year-old man with a central apnea resulted from unilateral medullary infarction. He was admitted because of cerebellar ataxia, dysarthria and dysphasia of abrupt onset. After the injection of diazepam for alcohol forbidden syndrome, he induced complete apnea and required the endotracheal intubation. At the spontaneous respiration under room air, his arterial blood gas showed hypercapnea without hypoxemia, and he fell into severe hypoventilation when hypnotic drug was injected. Respisomnogram revealed the frequent presence of central apnea both while he was awake and asleep. MRI demonstrated an abnormal high intensity area on T2 weighted image at the right lateral medulla just below the ponto-medullary junction. At autopsy, areas of the infarction were limited within the right lateral medulla, including lateral portion of the medullary reticular formation, the ambigual nucleus, one part of the solitary nuclear complex, the inferior cerebellar peduncle and the spinal trigeminal nucleus. However, the dorsomotor nucleus of vagus was completely free from the infarct lesion. There was no other lesion within central nervous system. Such a distribution seemed the minimal extent of the lesion responsible for central, apnea compared to the previous reports. We suggest that central apnea occurs not infrequently in the cases of Wallenberg's syndrome.
我们在此报告一名64岁男性，其中枢性呼吸暂停由单侧延髓梗死所致。他因突然出现的小脑共济失调、构音障碍和吞咽困难入院。在因酒精戒断综合征注射地西泮后，他出现了完全性呼吸暂停，需要进行气管插管。在室内空气中自主呼吸时，他的动脉血气显示存在高碳酸血症但无低氧血症，并且在注射催眠药物时陷入严重的通气不足。呼吸描记图显示他在清醒和睡眠时均频繁出现中枢性呼吸暂停。MRI显示在脑桥延髓交界处下方右侧延髓的T2加权图像上有异常高信号区。尸检时，梗死区域局限于右侧延髓内，包括延髓网状结构的外侧部分、疑核、孤束核复合体的一部分、小脑下脚和三叉神经脊束核。然而，迷走神经背核完全没有梗死病变。中枢神经系统内没有其他病变。与先前的报告相比，这样的分布似乎是导致中枢性呼吸暂停的最小病变范围。我们认为在延髓背外侧综合征的病例中，中枢性呼吸暂停并不少见。
