scholarly journals Efficacy of Tracheostomy for Central Alveolar Hypoventilation Syndrome Caused by Lateral Medullary Infarction

2014 ◽  
Vol 81 (4) ◽  
pp. 276-284 ◽  
Author(s):  
Masahiro Mishina ◽  
Seiji Ohkubo ◽  
Nobuo Kamiya ◽  
Arata Abe ◽  
Satoshi Suda ◽  
...  
Keyword(s):  
Lateral Medullary Infarction ◽  
Alveolar Hypoventilation ◽  
Hypoventilation Syndrome ◽  
Medullary Infarction

101 Dispelling the curse: improvement of ventilatory drive in central alveolar hypoventilation syndrome after medullary infarction

2018 ◽  
Vol 89 (6) ◽  
pp. A40.1-A40
Author(s):  
Marco Fedi ◽  
Shi Hong Shen ◽  
Bruce Campbell ◽  
Mathias Dutschmann ◽  
Terrence O’brien ◽  
...  
Keyword(s):  
Respiratory Rate ◽  
Ventilatory Response ◽  
List Type ◽  
Close Monitoring ◽  
Functional Neuroanatomy ◽  
Lateral Medullary Infarction ◽  
Ventilatory Drive ◽  
Alveolar Hypoventilation ◽  
Hypoventilation Syndrome ◽  
Medullary Infarction

IntroductionCentral alveolar hypoventilation syndrome (CAHS) is a rare complication of stroke affecting the medullary respiratory centre. CAHS is characterised by impaired ventilatory response to CO2 leading to hypoventilation, hyper-capnoea and coma. Experimental studies have linked this syndrome to areas in the dorsal and ventrolateral medulla. CAHS is associated with long-term invasive ventilatory support, high mortality and morbidity. It is unclear whether sensitivity to CO2 can improve after the initial ischaemic medullary insult.CaseA 78 year old woman presenting with CAHS secondary to a unilateral left posterior inferior cerebellar artery infarction. MRI images confirmed that dorsal and ventrolateral medullary areas were affected. The patient was intubated initially for hyper-capnoeic respiratory failure and required a tracheostomy for ongoing respiratory support. To assess progress of respiratory recovery, we measured the patient’s ventilatory response to PaCO2 at 5, 7, and 14 days of admission. Parameters recorded included PaO2, ETCO2, PaCO2, pH, respiratory rate, and minute ventilation. During this time the patient underwent progressive periods of unsupported ventilation with close monitoring. Statistical correlation between respiratory rate and CO2 was measured by Pearson’s correlation coefficient (R). Her RR initially did not increase with PaCO2 during spontaneous ventilation (R=0.2604 p=0.077). Apnoeic episodes were frequent up to 41 episodes per 30 min of observation lasting up to 30 s. On day 7(R=0.7203 p<0.05) and up to day 14 (R=0.6295 p<0.05), there was a progressive statistically significant improvement in positive correlation between PCO2 and respiratory rate. This was associated with a reduction in apnoeic episodes possibly reflecting a recovery in ventilatory drive.ConclusionThis is the first detailed report demonstrating spontaneous recovery in CO2 responsiveness in the setting of CAHS secondary to unilateral medullary stroke. Plasticity of structures such as the retro-trapezoid nucleus are likely to play a role in recovery of CO2 sensitivity.References. Harper, et al. Functional neuroanatomy and sleep-disordered breathing: implications for autonomic regulation. Anatomical record2012;295(9):1385–95.. Mishina, et al. Efficacy of tracheostomy for central alveolar hypoventilation syndrome caused by lateral medullary infarction. Journal of Nippon Medical School2014;81(4):276–84.

Network Localization of Central Hypoventilation Syndrome in Lateral Medullary Infarction

2020 ◽  
Vol 30 (6) ◽  
pp. 875-881
Author(s):  
Appaswamy Prabhakar ◽  
Ajith Sivadasan ◽  
Atif Shaikh ◽  
Sanjith Aaron ◽  
Rohit Benjamin ◽  
...  
Keyword(s):  
Lateral Medullary Infarction ◽  
Network Localization ◽  
Central Hypoventilation ◽  
Hypoventilation Syndrome ◽  
Medullary Infarction

Effect of Transcutaneous Vagus Nerve Stimulation in Dysphagia After Lateral Medullary Infarction: A Case Report

2019 ◽  
Vol 28 (4) ◽  
pp. 1381-1387
Author(s):  
Ying Yuan ◽  
Jie Wang ◽  
Dongyu Wu ◽  
Dahua Zhang ◽  
Weiqun Song
Keyword(s):  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Rating Scale ◽  
Tube Feeding ◽  
Nasogastric Feeding ◽  
Lateral Medullary Infarction ◽  
Severe Dysphagia ◽  
Transcutaneous Vagus Nerve Stimulation ◽  
Medullary Infarction

Purpose Severe dysphagia with weak pharyngeal peristalsis after dorsal lateral medullary infarction (LMI) requires long-term tube feeding. However, no study is currently available on therapeutic effectiveness in severe dysphagia caused by nuclear damage of vagus nerve after dorsal LMI. The purpose of the present investigation was to explore the potential of transcutaneous vagus nerve stimulation (tVNS) to improve severe dysphagia with weak pharyngeal peristalsis after dorsal LMI. Method We assessed the efficacy of 6-week tVNS in a 28-year-old woman presented with persisting severe dysphagia after dorsal LMI who had been on nasogastric feeding for 6 months. tVNS was applied for 20 min twice a day, 5 days a week, for 6 weeks. The outcome measures included saliva spitted, Swallow Function Scoring System, Functional Oral Intake Scale, Clinical Assessment of Dysphagia With Wallenberg Syndrome, Yale Pharyngeal Residue Severity Rating Scale, and upper esophagus X-ray examination. Results After tVNS, the patient was advanced to a full oral diet without head rotation or spitting. No saliva residue was found in the valleculae and pyriform sinuses. Contrast medium freely passed through the upper esophageal sphincter. Conclusion Our findings suggest that tVNS might provide a useful means for recovery of severe dysphagia with weak pharyngeal peristalsis after dorsal LMI. Supplemental Material https://doi.org/10.23641/asha.9755438

Spontaneous, headshaking, and positional nystagmus in post-lateral medullary infarction dizziness

2016 ◽  
Vol 368 ◽  
pp. 249-253 ◽  
Author(s):  
Kazumitsu Amari ◽  
Yosuke Kudo ◽  
Kosuke Watanabe ◽  
Masahiro Yamamoto ◽  
Koji Takahashi ◽  
...  
Keyword(s):  
Positional Nystagmus ◽  
Lateral Medullary Infarction ◽  
Medullary Infarction

Lateral Medullary Infarction with Contralateral Segmental Dysesthesia and Ipsilateral Headache: A Case Report

2021 ◽  
Vol 17 ◽  
Author(s):  
Renjie Wang ◽  
Yankun Shao ◽  
Lei Xu
Keyword(s):  
Medulla Oblongata ◽  
Clinical Manifestations ◽  
Lateral Medullary Infarction ◽  
Case Presentation ◽  
Specific Sign ◽  
Temperature Sense ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
The Brain ◽  
Medullary Infarction

Introduction: The medulla oblongata is the lowest segment of the brain stem, located adjacent to the spinal cord, with a complex anatomical structure. Thus, a small injury to the medulla oblongata can show complex clinical manifestations. Case Presentation: A patient experienced dysesthesia, which manifested as numbness in her right lower limb and decreased temperature sense, and dizziness 20 days before admission. The numbness worsened 1 week before admission, reaching the right thoracic (T) 12 dermatomes. Her thermoception below the T12 dermatomes decreased, and the degree of dizziness increased, accompanied by nausea and vomiting. Magnetic resonance imaging (MRI) of the neck, chest, and abdomen performed at a local hospital showed no abnormalities. MRI of the brain was performed after admission. One week after admission, she experienced a severe headache in the upper left periorbital area. The numbness extended to T4, and thermoception decreased below T4. Diagnosis: Lateral medullary infarction. Interventions: Anti-platelet aggregation and mitochondrial nutritional therapies were performed along with treatments for improving circulation and establishing collateral circulation. Outcomes: The intensity of limb numbness decreased, and the symptoms of headache and dizziness resolved. Conclusion: Lesions leading to segmental sensory disorders can occur in the medulla oblongata. Ipsilateral headaches with contralateral segmental paresthesia can be a specific sign of lateral medullary infarction.

Characteristics and Prognostic Factors of Swallowing Dysfunction in Patients with Lateral Medullary Infarction

2021 ◽  
Vol 30 (12) ◽  
pp. 106122
Author(s):  
Naoyuki Hara ◽  
Masahiro Nakamori ◽  
Tomoko Ayukawa ◽  
Hayato Matsushima ◽  
Yuki Hayashi ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Lateral Medullary Infarction ◽  
Swallowing Dysfunction ◽  
Medullary Infarction
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