Tanaka Katsuhiro, Kanamaru Hideki, Morikawa Atsunori, Kawaguchi Kenji
Department of Neurosurgery, NHO Mie Chuo Medical Center, Mie, Japan.
Department of Neurosurgery, Suzuka General Hospital, Suzuka, Mie, Japan.
NMC Case Rep J. 2016 Sep 7;3(4):133-136. doi: 10.2176/nmccrj.cr.2016-0067. eCollection 2016 Oct.
Lateral medullary infarction rarely leads to central hypoventilation syndrome (CHS). CHS is a life-threatening disorder characterized by hypoventilation during sleep. We report the first case of CHS as a complication of lateral medullary infarction after endovascular treatment. A 65-year-old man presented twice with severe headache. Computed tomography revealed subarachnoid hemorrhage and cerebral angiography showed a right vertebral dissecting aneurysm involving the posterior inferior cerebellar artery. After emergent endovascular patent artery occlusion, he developed Wallenberg syndrome and experienced apnea and a conscious disturbance episode due to CHS on postoperative days 6 and 16. Intensive respiratory care including intubation, tracheostomy, mechanical ventilation, and rehabilitation prevented subsequent recurrence of apnea and the CHS resolved completely. CHS after unilateral medullary infarction involving respiratory centers tends to occur in the acute and subacute phase and may be lethal without careful respiratory management.
延髓外侧梗死很少导致中枢性低通气综合征（CHS）。CHS是一种以睡眠期间低通气为特征的危及生命的疾病。我们报告了首例经血管内治疗后延髓外侧梗死并发CHS的病例。一名65岁男性两次出现严重头痛。计算机断层扫描显示蛛网膜下腔出血，脑血管造影显示右侧椎动脉夹层动脉瘤累及小脑后下动脉。在紧急进行血管内动脉闭塞术后，他出现了延髓背外侧综合征，并在术后第6天和第16天因CHS出现呼吸暂停和意识障碍发作。包括插管、气管切开、机械通气和康复在内的强化呼吸护理预防了随后的呼吸暂停复发，CHS完全缓解。累及呼吸中枢的单侧延髓梗死所致的CHS往往发生在急性期和亚急性期，若无仔细的呼吸管理可能会致命。
