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Chen J, Cen B, Hu F, Qiu Y, Xiao G, Zhou J, Ma X, Zhang F. Primary Brainstem Lymphoma: A Population-Based Study. Front Surg 2022; 9:829048. [PMID: 35874127 PMCID: PMC9299248 DOI: 10.3389/fsurg.2022.829048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPrimary brainstem lymphoma (PBSL) is rare and malignant. An understanding of this disease is lacking. We aimed to characterize clinical features, estimate survival, and explore survival-related factors of PBSL.MethodsPatients with a histological diagnosis of primary lymphoma in the brainstem (C71.7) from 1975 to 2016 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) program. Log-rank tests and univariate and multivariate Cox proportional hazard analyses were used to identify survival-related factors.ResultsPBSL constituted 2.7% of brainstem malignancies. The median age of the PBSL patients was 59.5 years. Diffuse large B cell lymphoma (n = 49, 84.5%) was the most prevalent histology among the 58 cases with reported specific lymphoma subtype. The majority of PBSLs were localized (n = 46, 52.3%), at low Ann Arbor Stage (I/II, n = 63, 70.5%), and presented as a single primary (n = 71, 80.7%). Chemotherapy was applied in 50 (56.8%) cases. Three-year overall survival (OS) and disease-specific survival (DSS) rates were 42.7% and 53.5%, respectively. Multivariate analyses showed that independent predictive/prognostic factors for OS were age (P = 0.004), tumor number (P = 0.029), and chemotherapy (P = 0.001); DSS-related factors only included age (P = 0.014) and chemotherapy (P = 0.008).ConclusionsWe estimated survival rates for PBSL patients. Factors associated with OS and DSS were also identified. Our findings addressed the importance of chemotherapy in treating PBSL patients.
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Affiliation(s)
- Junyu Chen
- General Hospital of the Yangtze River Shipping, Wuhan Brain Hospital, Wuhan, China
| | - Bo Cen
- General Hospital of the Yangtze River Shipping, Wuhan Brain Hospital, Wuhan, China
| | - Fei Hu
- General Hospital of the Yangtze River Shipping, Wuhan Brain Hospital, Wuhan, China
| | - Yong Qiu
- General Hospital of the Yangtze River Shipping, Wuhan Brain Hospital, Wuhan, China
| | - Guomin Xiao
- General Hospital of the Yangtze River Shipping, Wuhan Brain Hospital, Wuhan, China
| | - Junge Zhou
- General Hospital of the Yangtze River Shipping, Wuhan Brain Hospital, Wuhan, China
| | - Xiujian Ma
- German Cancer Research Center (DKFZ), DKFZ-ZMBH Alliance, Heidelberg, Germany
- Correspondence: Fangcheng Zhang Xiujian Ma
| | - Fangcheng Zhang
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Fangcheng Zhang Xiujian Ma
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Kajtazi NI, Khalid E, AlGhamdi J, Altaf S, AlHameed MH. Chronic inflammatory demyelinating polyneuropathy evolving to primary CNS lymphoma. BMJ Case Rep 2021; 14:e244767. [PMID: 34728507 PMCID: PMC8565527 DOI: 10.1136/bcr-2021-244767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/04/2022] Open
Abstract
A 56-year-old woman presented with 3 months history of all four limbs' numbness in glove and stocking distribution. A week before admission, she developed all four limbs' weakness and numbness. Brain and whole spine imaging revealed no lesions, and cerebrospinal fluid showed high protein. A nerve conduction study revealed severe sensorimotor polyneuropathy, and she was diagnosed with chronic inflammatory demyelinating polyneuropathy. We treated her with plasma exchange and later developed bilateral pulmonary embolism, deep venous thrombosis and worsening of weakness. The second set of seven sessions of plasma exchange gave her improvement in muscle strength. However, after a chest infection, another neurological deterioration occurred. The third set of plasma exchanges resulted in excellent response. Nineteen months into her illness she developed a headache followed by left upper limb weakness and focal seizures with left side involvement. Brain imaging revealed a right frontal enhancing lesion that required resection, and biopsy showed diffuse large B-cell lymphoma. She was treated with chemotherapy and whole-brain radiation therapy and remained with left-sided weakness.
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Affiliation(s)
- Naim Izet Kajtazi
- Department of Neurology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ehtesham Khalid
- Department of Neurology, Ideal Medicare Clinic, Multan, Pakistan
| | - Juman AlGhamdi
- Medical Imaging Administration, Intervention Neuroradiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Syed Altaf
- Department of Hematology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Majed H AlHameed
- Department of Neurology, King Fahad Medical City, Riyadh, Saudi Arabia
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Sheng X, Xu M, Li X. A Case of Primary Central Nervous System Lymphoma Mimic Neuromyelitis Optica. Transl Neurosci 2020; 11:28-33. [PMID: 32161683 PMCID: PMC7053397 DOI: 10.1515/tnsci-2020-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/27/2020] [Indexed: 11/29/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is rare. And the symptoms of PCNSL are atypical, it is extremely easy to be misdiagnosed as other diseases. However, early treatment is crucial which is requesting early diagnosis. We report a case of a 47-year-old man who was initially diagnosed as neuromyelitis optica (NMO) on the basis of clinical findings, slightly high Aquaporin4 (AQP4) (1:10) and high signals of magnetic resonance imaging. Though his symptoms progressively improved after steroid pulse treatment, but worse when steroid was decreased to 40 mg per day. We considered the patient should be diagnosed as PCNSL. After the examination of magnetic resonance spectroscopy (MRS) and positron emission tomography (PET), the results indicated PCNSL was most possible. Therefore we gave him stereotactic biopsy of deep of supratentorial, which showed non-Hodgkin malignant B-cell lymphoma.
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Affiliation(s)
- Xixi Sheng
- Department of Neurology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Address: No. 79 Qing-Chun Road, Hangzhou, Zhejiang 310003, PR China
| | - Mingwei Xu
- Department of Neurology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Address: No. 79 Qing-Chun Road, Hangzhou, Zhejiang 310003, PR China
| | - Xia Li
- Department of Neurology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Address: No. 79 Qing-Chun Road, Hangzhou, Zhejiang 310003, PR China
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Murata S, Takahashi S, Kunieda H, Oki K, Nakamura M. A case of central neurogenic hyperventilation without tachypnoea. Respirol Case Rep 2019; 7:e00462. [PMID: 31346469 PMCID: PMC6635121 DOI: 10.1002/rcr2.462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/12/2019] [Accepted: 06/18/2019] [Indexed: 11/13/2022] Open
Abstract
Central neurogenic hyperventilation (CNH) is a rare condition, with 37 cases reported in the literature to date. The underlying mechanisms remain unclear. Primary central nervous system lymphoma (PCNSL) is the most common cause of CNH, with 17 cases reported so far. Among these, CNH was usually accompanied by tachypnoea. Only two cases, including the present case, showed CNH with normal respiratory rate. Here, we present a case of PCNSL-induced CNH in a 60-year-old man. Magnetic resonance imaging of the brain demonstrated hyperintensity of the left cerebral cortex, basal ganglia, corona radiata, midbrain, and ventral pons on fluid-attenuated inversion recovery. The patient complained of dyspnoea and showed hyperventilation without tachypnoea on admission or during hospitalization. Examining CNH cases without tachypnoea and comparing those cases to cases of CNH with tachypnoea might provide new insights into the mechanisms of CNH. Moreover, it should be remembered that CNH can occur without tachypnoea.
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Affiliation(s)
- Saori Murata
- Department of Pulmonary MedicineTokyo Saiseikai Central HospitalTokyoJapan
| | - Saeko Takahashi
- Department of Pulmonary MedicineTokyo Saiseikai Central HospitalTokyoJapan
| | - Hisako Kunieda
- Department of Hematology and OncologyTokyo Saiseikai Central HospitalTokyoJapan
| | - Koichi Oki
- Department of NeurologyTokyo Saiseikai Central HospitalTokyoJapan
| | - Morio Nakamura
- Department of Pulmonary MedicineTokyo Saiseikai Central HospitalTokyoJapan
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Akay A, Rüksen M, Islekel S. Magnetic Resonance Imaging-guided Stereotactic Biopsy: A Review of 83 Cases with Outcomes. Asian J Neurosurg 2019; 14:90-95. [PMID: 30937016 PMCID: PMC6417362 DOI: 10.4103/ajns.ajns_81_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: The purpose of this study was to determine the relationship between the radiological and histopathological distribution of the cerebral lesions diagnosed with stereotactic biopsy (STB) procedure and its outcomes. Materials and Methods: In the current study, a retrospective analysis of 83 patients that underwent the STB in our clinic from January 2011 to December 2015 was made. T1-weighted contrast-enhanced cranial magnetic resonance imaging examinations were performed on patients on whom Leksell stereotactic frame system was installed. The histopathological and the radiological data derived from the STB procedure were classified. Results: In terms of localization, glial tumor (56.6%) was the most common lesion in all regions, except for the multifocal lesions. Contrary to the common knowledge, lymphoma (14.4%) was found to be the most common lesion among multifocal lesions. The success of obtaining positive STB samples in the current series was 95.2% and the complication rate was 3.6%. Conclusion: Had a routine computed tomography scan been performed on each patient in this series, the number of clinically insignificant small intracerebral hematomas would have probably been higher. Nevertheless, the rate of the STB sampling accuracy and the complication rate were similar to those reported in the relevant literature.
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Affiliation(s)
- Ali Akay
- Department of Neurosurgery, Kent Hospital, Izmir, Turkey
| | - Mete Rüksen
- Department of Neurosurgery, Kent Hospital, Izmir, Turkey
| | - Sertaç Islekel
- Department of Neurosurgery, Kent Hospital, Izmir, Turkey
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Primary central nervous system lymphoma mimicking cerebellopontine angle tumour. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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8
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Berrocal-Izquierdo N, Muñoz F, Bosch J, Molet J. Primary central nervous system lymphoma mimicking cerebellopontine angle tumour. Neurologia 2016; 33:614-616. [PMID: 27452624 DOI: 10.1016/j.nrl.2016.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/03/2016] [Accepted: 06/09/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- N Berrocal-Izquierdo
- Servicio de Neurología, SCIAS, Hospital de Barcelona, Barcelona, España; Servicio de Neurología, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España.
| | - F Muñoz
- Servicio de Neurocirugía, SCIAS, Hospital de Barcelona, Barcelona, España; Servicio de Neurocirugía, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J Bosch
- Servicio de Neurología, SCIAS, Hospital de Barcelona, Barcelona, España
| | - J Molet
- Servicio de Neurocirugía, SCIAS, Hospital de Barcelona, Barcelona, España; Servicio de Neurocirugía, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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Primary central nervous system lymphoma mimicking Bickerstaff’s encephalitis. Neurol Sci 2013; 35:139-41. [DOI: 10.1007/s10072-013-1533-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 08/29/2013] [Indexed: 10/26/2022]
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Guzmán-De-Villoria JA, Ferreiro-Argüelles C, Fernández-García P. Differential diagnosis of T2 hyperintense brainstem lesions: Part 2. Diffuse lesions. Semin Ultrasound CT MR 2010; 31:260-74. [PMID: 20483393 DOI: 10.1053/j.sult.2010.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Diffuse brainstem lesions are poorly defined, often large abnormalities and include tumors (gliomas and lymphomas) vasculitis (Behçet's disease), traumatic brainstem injury, degenerative disorders (Wallerian degeneration), infections, processes secondary to systemic conditions (central pontine myelinolysis, hypertensive or hepatic encephalopathy), and ischemic pathology (leukoaraiosis). Magnetic resonance imaging is the most appropriate imaging modality to use in evaluating lesions of this type, but often findings are nonspecific. Therefore, radiologists need to bear in mind such additional information as patient age and clinical features in making a differential diagnosis.
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Affiliation(s)
- Juan A Guzmán-De-Villoria
- Department of Radiology/Neuroradiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Masroujeh R, Otrock ZK, Yamout B, Jabbour MN, Bazarbachi A. Myasthenia gravis developing in a patient with CNS lymphoma. Int J Hematol 2010; 91:522-4. [DOI: 10.1007/s12185-010-0503-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 01/04/2010] [Accepted: 01/13/2010] [Indexed: 11/29/2022]
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13
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Laigle-Donadey F, Iraqi W, Straus C, Martin-Duverneuil N, Fénelon G, Hoang-Xuan K. [Primary central nervous system lymphoma presenting with central neurogenic hyperventilation. A case report and review of the literature]. Rev Neurol (Paris) 2005; 161:940-8. [PMID: 16365623 DOI: 10.1016/s0035-3787(05)85157-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Central neurogenic hyperventilation (CNH) in an awake patient is a rare entity. OBSERVATION We report here a 54-year-old patient who developed central neurogenic hyperventilation as the initial presentation of a primary central nervous system lymphoma located in the brainstem. CONCLUSION The patient's hyperventilation resolved completely with chemotherapy for primary CNS lymphoma. Most of the cases reported in the literature are related to a diffuse tumor of the brainstem with an intriguing overrepresentation of primary CNS lymphoma. The pathogenesis of CNH is discussed.
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Affiliation(s)
- F Laigle-Donadey
- Service de Neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris.
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Ikeda K, Baba S, Iwasaki Y. Pseudomyasthenia in a patient with pontine glioma. Clin Neurol Neurosurg 2005; 108:809-10. [PMID: 16289768 DOI: 10.1016/j.clineuro.2005.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Revised: 09/30/2005] [Accepted: 10/08/2005] [Indexed: 10/25/2022]
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15
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Milea D, Laforet P, Eymard B. [Atypical ocular myasthenia gravis]. Rev Neurol (Paris) 2005; 161:543-8. [PMID: 16106805 DOI: 10.1016/s0035-3787(05)85088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The diagnosis of ocular myasthenia gravis is rarely in doubt in patients with a proper history and typical clinical findings. However, myasthenia gravis can mimick any pupil-sparing eye movement disorder and several diseases may masquerade myasthenia gravis. We review the atypical presentations and differential diagnoses in ocular myasthenia gravis, describing four patients with some of these conditions (4th nerve palsy, near spasm reflex, one-and-a-half syndrome, orbital meningioma). The correct interpretation of the clinical findings associated with appropriate neuro-imaging studies allowed the appropriate diagnosis in these cases.
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Affiliation(s)
- D Milea
- Service d'Ophtalmologie, Groupe Hospitalier de la Pitié-Salpêtrière, Paris.
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16
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Akkaya OF, Sahin HA, Senel A, Ertaş B, Kinay K, Onar MK. Brain stem lesion mimicking myasthenia gravis. Clin Neurol Neurosurg 2005; 107:246-8. [PMID: 15823683 DOI: 10.1016/j.clineuro.2004.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2003] [Revised: 05/24/2004] [Accepted: 06/08/2004] [Indexed: 11/24/2022]
Abstract
Brain stem masses may mimic Myasthenia gravis (MG), clinically and electrophysiologically. We present a 38 year-old female patient with a brain stem mass, who has clinical features similar with MG, and revealed a decremental response to repetitive nerve stimulation. Brain stem mass was removed by surgery. In the postoperative period, her complaints were regressed. Control repetitive nerve stimulation examination was normal.
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Affiliation(s)
- Omer F Akkaya
- Department of Neurology, Ondokuz Mayis University Medical Faculty, 55139 Kurupelit-Samsun, Turkey.
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Buss A, Assmus A, Weidemann J, Sellhaus B, Lorenzen J, Block F. [Diagnosis of an initial infratentorial central nervous system B-cell lymphoma during prolonged cortisone medication]. DER NERVENARZT 2004; 75:1217-21. [PMID: 15224176 DOI: 10.1007/s00115-004-1725-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We present a patient with primary central nervous system B-cell lymphoma. He had suffered from slowly developing weight loss and presented to us with disorientation, seizures, and a supranuclear gaze disturbance. The patient was dismissed with the primary diagnosis of autoimmune encephalitis of the brainstem and put on oral corticosteroids. Four months later, his health status had deteriorated, and at that time diagnostic methods pointed to a cerebral lymphoma. Stereotactic biopsy with subsequent immunohistochemistry and polymerase chain reaction analysis revealed a highly malignant B-cell lymphoma of the CNS, despite prolonged corticosteroid treatment. The patient was treated with whole brain radiotherapy.
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Affiliation(s)
- A Buss
- Abteilung für Neurologie, Klinikum der RWTH Aachen.
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Shahar E, Postovsky S, Bennett O. Central neurogenic hyperventilation in a conscious child associated with glioblastoma multiforme. Pediatr Neurol 2004; 30:287-90. [PMID: 15087110 DOI: 10.1016/j.pediatrneurol.2003.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2003] [Accepted: 10/06/2003] [Indexed: 11/17/2022]
Abstract
Central neurogenic hyperventilation refers to progressive tachypnea leading to hypocarbia and respiratory alkalosis caused by cortical disorders, initially reported in comatose patients with mainly pontine infarction. Central neurogenic hyperventilation in conscious patients is even rarer, numbering around 30 reported cases including seven children, mainly associated with infiltrative gliomas and lymphomas of the brainstem and pons. We report the evolution of central neurogenic hyperventilation in a conscious child associated with an infiltrative glioblastoma multiforme diagnosed 1 year before admission. He presented with progressive tachypnea and dyspnea of 1 week duration. On examination he was fully alert and aware of his respiratory disorder. Respiratory rate was 56 breaths per minute using accessory respiratory muscles. Hyperventilation was unchanged during sleep. Arterial blood gases disclosed marked hypocarbia: Pco(2) of 8 mm Hg resulting in severe respiratory alkalosis at pH of 7.8. Central neurogenic hyperventilation was therefore suggested after exclusion of other respiratory or cardiac disorders. The exaggerated tachypnea persisted along with respiratory alkalosis. Over a period of 2 months his overall state markedly deteriorated; he lapsed into coma, and finally succumbed after involvement of medullary cardiovascular centers. Although extremely rare in the pediatric age group, central neurogenic hyperventilation should be suspected in any alert child presenting with unexplained increasing tachypnea and hypocarbia leading to respiratory alkalosis. The evolution of such a disorder may be an alarming sign of ensuing deterioration in patients with tumors of the brainstem and medulla before cardiovascular derangement.
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Affiliation(s)
- Eli Shahar
- Child Neurology Unit and Epilepsy Service, Haifa, Israel
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