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Karn M, Mahato BK, Sah R, Kandel D, Sapkota S. "You Sleep, You Die": A Rare Clinical Case of Ondine's Curse after Posterior Fossa Surgery. Case Rep Surg 2023; 2023:3113428. [PMID: 37727799 PMCID: PMC10506874 DOI: 10.1155/2023/3113428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 08/06/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023] Open
Abstract
Ondine's curse is a rare condition in which breathing is preserved while awake, but there is absence of autonomic control of ventilation. It is a potentially fatal complication that may result rarely from surgery in posterior fossa in area close to respiratory centers. We describe a patient with posterior fossa hemangioblastoma who underwent subtotal resection via telovelar approach and developed acquired Ondine's curse postoperatively. The patient's presentation and management are described. Besides that, Ondine's is a great example of how modern medicine is linked to ancient literature, and thus, its anecdotal history is also described.
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Affiliation(s)
- Mitesh Karn
- Department of Neurosurgery, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | - Basant Kumar Mahato
- Department of Neurosurgery, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | - Ranjan Sah
- Department of Neurosurgery, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | - Dipendra Kandel
- Department of Neurosurgery, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | - Shabal Sapkota
- Department of Neurosurgery, Al Tadawi Specialty Hospital, Dubai, UAE
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2
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Saito T, Itabashi R, Kawabata Y, Yazawa Y. Clinical characteristics of patients with lateral medullary infarction who had fatal respiratory failure. J Neurol Sci 2022; 434:120167. [DOI: 10.1016/j.jns.2022.120167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/06/2022] [Accepted: 01/18/2022] [Indexed: 11/25/2022]
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3
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Demartini Z, Maranha Gatto LA, Koppe GL, Francisco AN, Guerios EE. Ondine's curse: myth meets reality. Sleep Med X 2021; 2:100012. [PMID: 33870169 PMCID: PMC8041132 DOI: 10.1016/j.sleepx.2020.100012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 11/21/2022] Open
Abstract
Ondine's curse is one of the most enchanting mythical tales in the field of Medicine. The nymph Ondine was an immortal water spirit who became human after falling in love for a man, marrying him, and having a baby. In one of the versions of the tale, when she caught her husband sleeping with another woman, she cursed him to remain awake in order to control his own breathing. During the 19th century, the rare syndrome characterized by loss of autonomic breath control, while voluntary respiration remains intact, was cleverly named “Ondine's curse”. Nowadays, the term Ondine's curse is usually associated with congenital central hypoventilation syndrome; however, in medical literature, it also designates several respiratory disorders. Here, we present a review of the myth focused on history, arts and medicine.
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Affiliation(s)
- Zeferino Demartini
- Complexo Hospital de Clinicas - Universidade Federal of Parana, Curitiba, PR, Brazil
- Hospital Universitário Cajuru, Pontifical Catholic University of Parana - PUCPR, Curitiba, PR, Brazil
- Corresponding author. Departamento de Neurocirurgia, Rua General Carneiro 181, 8º andar, Curitiba, PR, Brazil.
| | | | - Gelson Luis Koppe
- Hospital Universitário Cajuru, Pontifical Catholic University of Parana - PUCPR, Curitiba, PR, Brazil
| | | | - Enio Eduardo Guerios
- Complexo Hospital de Clinicas - Universidade Federal of Parana, Curitiba, PR, Brazil
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Kim DJ, Cho JW, Kim HW, Choi JS, Mun SJ. Case of Treatment Using Adaptive Servo-Ventilation in a Patient with Central Sleep Apnea after a Lateral Medullary Infarction. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2020. [DOI: 10.15324/kjcls.2020.52.3.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Dae Jin Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Wook Cho
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun Woo Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jeong Su Choi
- Department of Health and Safety Convergence Science, Graduate School, Korea University, Seoul, Korea
| | - Sue Jean Mun
- Department of Otorhinolaryngology-Head & Neck Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
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Orrego-González E, Medina-Rincón GJ, Martínez-Gil S, Botero-Meneses JS. Ondine’s curse: the origin of the myth. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:238-240. [DOI: 10.1590/0004-282x20190162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/16/2019] [Indexed: 11/22/2022]
Abstract
ABSTRACT Central alveolar hypoventilation syndrome has been known for decades as Ondine’s curse. It was named as such after a German myth. Although most of the stories resemble one another, word of mouth has led to misinterpretation of this tale among the medical community. The present paper reviews the original narrative, its characters, and how it is linked to the most relevant aspects of the disease.
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Chronic Pain: Lesions. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Olry R, Haines DE. Ondine's curse: With Jean Giraudoux's finishing touches. JOURNAL OF THE HISTORY OF THE NEUROSCIENCES 2018; 27:390-395. [PMID: 28532281 DOI: 10.1080/0964704x.2017.1326243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Régis Olry
- a Département d'Anatomie , Université du Québec à Trois-Rivières , Trois-Rivières , Québec , Canada
| | - Duane E Haines
- b Department of Neurobiology and Anatomy , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
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Abstract
Congenital central hypoventilation syndrome (CCHS) causes predominantly sleep apnoea and is one of a growing number of inherited disorders characterised by autonomic nervous system dysfunction/dysregulation (ANSD). In association with Hirschsprung's disease (HSCR), it presents as Haddad's syndrome. We report a case of Haddad's syndrome complicated by sinus node dysfunction.
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Affiliation(s)
- Alexander Tsoutsinos
- Department of Paediatric Cardiology, Onassis Cardiac Surgery Centre, Athens, Greece
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Konrad P. Dorsal root entry zone lesion, midline myelotomy and anterolateral cordotomy. Neurosurg Clin N Am 2015; 25:699-722. [PMID: 25240658 DOI: 10.1016/j.nec.2014.07.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This review encompasses the most common spinal cord lesioning procedures used for the treatment of pain: dorsal root entry zone lesioning, open cordotomy, percutaneous cordotomy, and midline myelotomy. A literature review and summary of each technique regarding relevant anatomy, patient selection, surgical technique, outcomes, and complications are discussed. A general review of somatic and visceral pain pathways of the spinal cord is included, as each procedure requires an understanding of the advantages and disadvantages of various approaches to lesioning the spinal cord for pain. Neurosurgical education of these rarely used procedures needs to be included in residency and fellowship training.
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Affiliation(s)
- Peter Konrad
- Functional Neurosurgery, Neurological Surgery and Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
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Lake WB, Konrad PE. Cordotomy procedures for cancer pain: A discussion of surgical procedures and a review of the literature. World J Surg Proced 2015; 5:111-118. [DOI: 10.5412/wjsp.v5.i1.111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 01/02/2015] [Accepted: 02/02/2015] [Indexed: 02/06/2023] Open
Abstract
Treating pain in patients with terminal cancer is challenging but essential part of their care. Most patients can be managed with pharmacological options but for some these pain control methods are inadequate. Ablative spinal procedures offer an alternative method of pain control for cancer patients with a terminal diagnosis that are failing to have their pain controlled sufficiently by other methods. This paper provides a review of ablative spinal procedures for control of cancer pain. Patient selection, surgical methods, outcomes and complications are discussed in detail for cordotomy, dorsal root entry zone (DREZ) lesioning and midline myelotomy. Cordotomy is primarily done by a percutaneous method and it is best suited for patients with unilateral somatic limb and trunk pain such as due to sarcoma. Possible complications include unilateral weakness possibly respiratory abnormalities. Approximately 90% of patients have significant immediate pain relief following percutaneous cordotomy but increasing portions of patients have pain recurrence as the follow-up period increases beyond one year. The DREZ lesion procedure is best suited to patients with plexus invasion due to malignancy and pain confined to one limb. Possible complications of DREZ procedures include hemiparesis and decreased proprioception. Midline myelotomy is best suited for bilateral abdominal, pelvic or lower extremity pain. Division of the commissure is necessary to address bilateral lower extremity pain. This procedure is relatively rare but published case series demonstrate satisfactory pain control for over half of the patients undergoing the procedure. Possible complications include bilateral lower extremity weakness and diminished proprioception below the lesion level. Unlike cordotomy and DREZ this procedure offers visceral pain control as opposed to only somatic pain control. Ablative spinal procedures offer pain control for terminal cancer patients that are not able to managed medically. This paper provides an in depth review of these procedures with the hope of improving education regarding these underutilized procedures.
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Reddy GD, Okhuysen-Cawley R, Harsh V, Viswanathan A. Percutaneous CT-guided cordotomy for the treatment of pediatric cancer pain. J Neurosurg Pediatr 2013; 12:93-6. [PMID: 23682820 DOI: 10.3171/2013.4.peds12474] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Percutaneous cordotomy using CT guidance has been shown to be a safe and effective means of reducing pain in adults with cancer in 2 large case series. Its effectiveness in pediatric patients, however, has not been reported. Here, the authors present a case of CT-guided percutaneous cordotomy being used effectively for the treatment of unilateral limb pain in a 9-year-old boy suffering from metastatic medulloblastoma. The efficacy and minimally invasive nature of this procedure support its use in selected pediatric cases.
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Affiliation(s)
- Gaddum D Reddy
- Departments of Neurosurgery, MD Anderson Cancer Center, Houston, Texas, USA
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Abstract
Ondine's curse or central hypoventilation syndrome is most common congenital disorder which is diagnosed in infancy. In the majority of cases, no structural abnormality is identified. We describe the case of an 18-year-old patient who presented with Ondine's curse secondary to an os odontoideum.
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Affiliation(s)
- Emer Campbell
- Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital , 1345, Govan Road, Glasgow, G51 4TF
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Abstract
A wide variety of mechanisms can lead to the hypoventilation associated with various medical disorders, including derangements in central ventilatory control, mechanical impediments to breathing, and abnormalities in gas exchange leading to increased dead space ventilation. The pathogenesis of hypercapnia in obesity hypoventilation syndrome remains somewhat obscure, although in many patients comorbid obstructive sleep apnea appears to play an important role. Hypoventilation in neurologic or neuromuscular disorders is primarily explained by weakness of respiratory muscles, although some central nervous system diseases may affect control of breathing. In other chest wall disorders, obstructive airways disease, and cystic fibrosis, much of the pathogenesis is explained by mechanical impediments to breathing, but an element of increased dead space ventilation also often occurs. Central alveolar hypoventilation syndrome involves a genetically determined defect in central respiratory control. Treatment in all of these disorders involves coordinated management of the primary disorder (when possible) and, increasingly, the use of noninvasive positive pressure ventilation.
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Affiliation(s)
- Lee K Brown
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, 1101 Medical Arts Avenue NE, Building #2, Albuquerque, NM 87102, USA.
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Kapnadak SG, Mikolaenko I, Enfield K, Gress DR, Nathan BR. Ondine's curse with accompanying trigeminal and glossopharyngeal neuralgia secondary to medullary telangiectasia. Neurocrit Care 2010; 12:395-9. [PMID: 20066515 DOI: 10.1007/s12028-009-9321-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Central hypoventilation syndrome ("Ondine's Curse") is an infrequent disorder that can lead to serious acute or chronic health consequences. This syndrome, especially in adults, is rare, and even less frequent in the absence of clear pathogenic lesions on MRI. In addition, we are not aware of any previously reported cases with associated cranial nerve neuralgias. METHODS We describe a patient with baseline trigeminal and glossopharyngeal neuralgia, admitted with episodes of severe hypoventilatory failure of central origin, consistent with "Ondine's Curse". After evaluation, she was found to have a medullary capillary telangiectasia, thought to be the causative lesion, and which could explain her complete neurologic and hypoventilatory syndrome. The patient was treated with placement of a diaphragmatic pacing system, which has been effective thus far. RESULTS This case illustrates the need for investigation of centrally mediated apnea, especially when co-occurring cranial nerve neuralgia is present and cardiopulmonary evaluation is negative. It provides an example of capillary telangiectasia as the causative lesion, one that to our knowledge has not been reported before. CONCLUSIONS Placement of a diaphragmatic pacing system was warranted and became lifesaving as the patient was deemed to be severely incapacitated by chronic ventilatory insufficiency.
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Fracaso en el destete de la ventilación mecánica. La maldición de Ondine: caso clínico y revisión. Med Intensiva 2010; 34:282-5. [DOI: 10.1016/j.medin.2009.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 06/16/2009] [Accepted: 06/18/2009] [Indexed: 11/22/2022]
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Bonic EE, Stockwell CA, Kettner NW. Brain Stem Compression and Atlantoaxial Instability Secondary to Chronic Rheumatoid Arthritis in a 67-Year-Old Female. J Manipulative Physiol Ther 2010; 33:315-20. [DOI: 10.1016/j.jmpt.2010.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 12/30/2009] [Indexed: 10/19/2022]
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Abstract
The respiratory and central nervous systems are intimately connected through strict control of ventilation by central mechanisms. The exquisite sensitivity of central chemoreceptors and cerebral blood vessels to changes in central nervous system oxygenation mandate this type of control to maintain proper brain function. When diseases of the lung and respiratory system interfere with this fine balance, neurologic symptoms, sometimes severe, may develop. This article deals with the effects of abnormal ventilation on the nervous system.
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Affiliation(s)
- Joy E Dreibelbis
- Department of Neurology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 673, Rochester, NY 14642, USA
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Kanpolat Y, Ugur HC, Ayten M, Elhan AH. Computed tomography-guided percutaneous cordotomy for intractable pain in malignancy. Neurosurgery 2009; 64:ons187-93; discussion ons193-4. [PMID: 19240568 DOI: 10.1227/01.neu.0000335645.67282.03] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Pain, usually a response to tissue damage, is accepted as an unpleasant feeling generating a desire to escape from the causative stimulus. Although, in the early stages of malignant diseases, pain is seen in 5% to 10% of cases, this rate reaches nearly 90% in the terminal stage, and pain becomes a primary symptom. Cordotomy is one of the treatment choices in pain caused by malignancies localized unilaterally to the extremities as well as the thorax and the abdomen. METHODS The target of computed tomography (CT)-guided percutaneous cordotomy is the lateral spinothalamic tract located in the anterolateral region of the spinal cord at the C1-C2 level. Between 1987 and 2007, CT-guided percutaneous cordotomies were performed in 207 patients; most (193 patients) suffered from intractable pain related to malignancy. The patients' pain scores and Karnofsky Performance Scale scores were evaluated pre- and postoperatively. RESULTS The initial success rate of CT-guided percutaneous cordotomy was 92.5%. The success rate was higher in the malignancy group. In the cancer group, selective cordotomy (pain sensation denervated only in the painful region of the body) was achieved in 83%. In 12 cases, bilateral selective percutaneous cordotomy was successfully applied. CONCLUSION In the treatment of intractable pain, CT-guided cordotomy is an option in specially selected cases with malignancy. In this study, anatomic and technical details of the procedure and the experience gained from treating 207 patients over a 20-year period are discussed.
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Affiliation(s)
- Yucel Kanpolat
- Department of Neurosurgery, Ankara University School of Medicine, Sihhiye, Ankara, Turkey
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Little R. A 2-year old with no ventilator requirement but who cannot be extubated. Semin Pediatr Neurol 2008; 15:157-9; discussion 159. [PMID: 19073316 DOI: 10.1016/j.spen.2008.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 2-year-old boy was intubated during treatment for pneumonia. After resolution of the infection, he had no pulmonary requirement for ventilation and could function without it while awake. When he slept, however, he would have decreasing respiratory effort, increasing hypercapnia, and episodic apnea. This report provides an example of late-onset congenital central hypoventilation syndrome.
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Affiliation(s)
- Robert Little
- Phoenix Children's Hospital, Phoenix, AZ 85016, USA.
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Affiliation(s)
- Hiren Muzumdar
- Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467 2490, USA
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