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Allgood JE, Roe A, Sparks BB, Castillo M, Cruz A, Brooks AE, Brooks BD. The Correlation of Sleep Disturbance and Location of Glioma Tumors: A Narrative Review. J Clin Med 2023; 12:4058. [PMID: 37373751 DOI: 10.3390/jcm12124058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Sleep disturbance can occur when sleep centers of the brain, regions that are responsible for coordinating and generating healthy amounts of sleep, are disrupted by glioma growth or surgical resection. Several disorders cause disruptions to the average duration, quality, or patterns of sleep, resulting in sleep disturbance. It is unknown whether specific sleep disorders can be reliably correlated with glioma growth, but there are sufficient numbers of case reports to suggest that a connection is possible. In this manuscript, these case reports and retrospective chart reviews are considered in the context of the current primary literature on sleep disturbance and glioma diagnosis to identify a new and useful connection which warrants further systematic and scientific examination in preclinical animal models. Confirmation of the relationship between disruption of the sleep centers in the brain and glioma location could have significant implications for diagnostics, treatment, monitoring of metastasis/recurrence, and end-of-life considerations.
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Affiliation(s)
- JuliAnne E Allgood
- Department of Neuroscience, University of Wyoming, Laramie, WY 82071, USA
| | - Avery Roe
- College of Osteopathic Medicine, Rocky Vista University, Greenwood Village, CO 80112, USA
| | - Bridger B Sparks
- Department of Neuroscience, University of Wyoming, Laramie, WY 82071, USA
| | - Mercedes Castillo
- College of Osteopathic Medicine, Rocky Vista University, Greenwood Village, CO 80112, USA
| | - Angel Cruz
- College of Osteopathic Medicine, Rocky Vista University, Greenwood Village, CO 80112, USA
| | - Amanda E Brooks
- College of Osteopathic Medicine, Rocky Vista University, Greenwood Village, CO 80112, USA
| | - Benjamin D Brooks
- College of Osteopathic Medicine, Rocky Vista University, Greenwood Village, CO 80112, USA
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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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Hensen HA, Krishnan AV, Eckert DJ. Sleep-Disordered Breathing in People with Multiple Sclerosis: Prevalence, Pathophysiological Mechanisms, and Disease Consequences. Front Neurol 2018; 8:740. [PMID: 29379466 PMCID: PMC5775511 DOI: 10.3389/fneur.2017.00740] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/22/2017] [Indexed: 12/26/2022] Open
Abstract
Sleep problems are common in people with multiple sclerosis (MS). Reported prevalence rates of sleep-disordered breathing (SDB) vary between 0 and 87%. Differences in recruitment procedures and study designs likely contribute to the wide variance in reported prevalence rates of SBD in MS. This can make attempts to compare SDB rates in people with MS to the general population challenging. Little is known about the pathophysiological mechanisms that contribute to SDB in people with MS or whether MS contributes to SDB disease progression. However, compared to the general obstructive sleep apnea (OSA) population, there are clear differences in the clinical phenotypes of SDB in the MS population. For instance they are typically not obese and rates of SDB are often comparable or higher to the general population, despite the high female predominance of MS. Thus, the risk factors and pathophysiological causes of SDB in people with MS are likely to be different compared to people with OSA who do not have MS. There may be important bidirectional relationships between SDB and MS. Demyelinating lesions of MS in the brain stem and spinal cord could influence breathing control and upper airway muscle activity to cause SDB. Intermittent hypoxia caused by apneas during the night can increase oxidative stress and may worsen neurodegeneration in people with MS. In addition, inflammation and changes in cytokine levels may play a key role in the relationship between SDB and MS and their shared consequences. Indeed, fatigue, neurocognitive dysfunction, and depression may worsen considerably if both disorders coexist. Recent studies indicate that treatment of SDB in people with MS with conventional first-line therapy, continuous positive airway pressure therapy, can reduce fatigue and cognitive impairment. However, if the causes of SDB differ in people with MS, so too may the optimal therapy. Thus, many questions remain concerning the relationship between these two disorders and the underlying mechanisms and shared consequences. Improved understanding of these factors has the potential to unlock new therapeutic targets.
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Affiliation(s)
- Hanna A Hensen
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
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Brainstem gangliogliomas: prognostic factors, surgical indications and functional outcomes. J Neurooncol 2016; 128:445-53. [PMID: 27112924 DOI: 10.1007/s11060-016-2131-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
To explore the prognostic factors and discuss the surgical indications of brainstem gangliogliomas. Twenty-one patients with brainstem ganglioglioma were surgically treated at our hospital between 2006 and 2014. The clinical, radiological, operative, and pathological findings of these patients were retrospectively reviewed. The 3-years overall survival and event-free survival (EFS) rates were 90.5 % and 68.4 %, respectively. Four patients (4/18, 22 %) experienced a recurrence with a mean recurrence-free survival of 5.5 months and a mean follow-up of 37 months. Three patients died of surgery-related complications. Three growth patterns were identified: exophytic (6/21), intrinsic (2/21), and endo-exophytic (13/21). Eight patients (8/15, 53 %) harbored a BRAF V600E mutation. All recurrent tumors were endo-exophytic, and except the one without molecular information, were BRAF V600E mutants. A Cox hazard proportion ratio model was used to identify factors influencing EFS, including sex, age, location, growth patterns, extent of resection (EOR), and BRAF V600E mutation status. On univariate analysis, none of these factors reached statistical significance. Among them, EOR and growth patterns were strongly associated with each other (Fisher's exact test, P < 0.01). A multivariate analysis demonstrated that growth patterns were the only factor associated with EFS (P = 0.02; HR 49.05; 95 % CI 1.76-1365.13). Growth patterns may be useful to select surgery candidates and predict prognosis for patients with brainstem gangliogliomas. BRAF V600E was frequently present and appeared to be associated with shorter recurrence-free survival. Studies on BRAF V600E-targeted therapy for patients with high surgical risks are needed.
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Kim SD, Kim JH, Lee CY, Kim HW. Ganglioglioma in brainstem : case report and a review of literatures. J Korean Neurosurg Soc 2014; 55:164-6. [PMID: 24851154 PMCID: PMC4024818 DOI: 10.3340/jkns.2014.55.3.164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 10/25/2013] [Accepted: 02/28/2014] [Indexed: 11/27/2022] Open
Abstract
Ganglioglioma is an infrequent tumor of the central nervous system (CNS); mostly supratentorial region. But, they can occur anywhere in the central nervous system such as brainstem, cerebellopontine angle (CPA), thalamus, optic nerve and spinal cord. Although it occurs rarely, ganglioglioma should be included in the differential diagnosis of a posterior fossa mass because early recognition is important for treatment and patient counseling.
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Affiliation(s)
- Sung-Duk Kim
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
| | - Jong Hyun Kim
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
| | - Cheol-Young Lee
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea. ; Graduate School of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyun-Woo Kim
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
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Jung KJ, Park JY, Hwang DW, Kim JH, Kim JH. Ultrasonographic diaphragmatic motion analysis and its correlation with pulmonary function in hemiplegic stroke patients. Ann Rehabil Med 2014; 38:29-37. [PMID: 24639923 PMCID: PMC3953360 DOI: 10.5535/arm.2014.38.1.29] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 09/24/2013] [Indexed: 01/30/2023] Open
Abstract
Objective To evaluate diaphragmatic motion via M-mode ultrasonography and to correlate it with pulmonary function in stroke patients. Methods This was a preliminary study comprised of ten stroke patients and sixteen healthy volunteers. The M-mode ultrasonographic probe was positioned in the subcostal anterior region of the abdomen for transverse scanning of the diaphragm during quiet breathing, voluntary sniffing, and deep breathing. We analyzed diaphragmatic motion and the relationship between diaphragmatic motion and pulmonary function. Results All stroke patients had restrictive pulmonary dysfunction. Compared to that exhibited by control subjects, stroke patients exhibited a significant unilateral reduction in motion on the hemiplegic side, primarily during volitional breathing. Diaphragmatic excursion in right-hemiplegic patients was reduced on both sides compared to that in control subjects. However, diaphragmatic excursion was reduced only on the left side and increased on the right side in left-hemiplegic patients compared to that in control subjects. Left diaphragmatic motion during deep breathing correlated positively with forced vital capacity (rho=0.86, p=0.007) and forced expiratory volume in 1 second (rho=0.79, p=0.021). Conclusion Reductions in diaphragmatic motion and pulmonary function can occur in stroke patients. Thus, this should be assessed prior to the initiation of rehabilitation therapy, and M-mode ultrasonography can be used for this purpose. It is a non-invasive method providing quantitative information that is correlated with pulmonary function.
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Affiliation(s)
- Kang-Jae Jung
- Department of Rehabilitation Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Ji-Young Park
- Department of Rehabilitation Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Do-Won Hwang
- Department of Rehabilitation Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Jeong-Hawn Kim
- Department of Rehabilitation Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Jae-Hyung Kim
- Department of Rehabilitation Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
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Donson AM, Kleinschmidt-DeMasters BK, Aisner DL, Bemis LT, Birks DK, Levy JMM, Smith AA, Handler MH, Foreman NK, Rush SZ. Pediatric brainstem gangliogliomas show BRAF(V600E) mutation in a high percentage of cases. Brain Pathol 2013; 24:173-83. [PMID: 24238153 DOI: 10.1111/bpa.12103] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/06/2013] [Indexed: 12/01/2022] Open
Abstract
Brainstem gangliogliomas (GGs), often cannot be resected, have a much poorer prognosis than those located in more common supratentorial sites and may benefit from novel therapeutic approaches. Therapeutically targetable BRAF c.1799T>A (p.V600E) (BRAF(V600E) ) mutations are harbored in roughly 50% of collective GGs taken from all anatomical sites. Large numbers of pediatric brainstem GGs, however, have not been specifically assessed and anatomic-and age-restricted assessment of genetic and biological factors are becoming increasingly important. Pediatric brainstem GGs (n = 13), non-brainstem GGs (n = 11) and brainstem pilocytic astrocytomas (PAs) (n = 8) were screened by standard Sanger DNA sequencing of BRAF exon 15. Five of 13 (38%) pediatric GG harbored a definitive BRAF(V600E) mutation, with two others exhibiting an equivocal result by this method. BRAF(V600E) was also seen in five of 11 (45%) non-brainstem GGs and one of eight (13%) brainstem PAs. VE1 immunostaining for BRAF(V600E) showed concordance with sequencing in nine of nine brainstem GGs including the two cases equivocal by Sanger. The equivocal brainstem GGs were subsequently shown to harbor BRAF(V600E) using a novel, more sensitive, RNA-sequencing approach, yielding a final BRAF(V600E) mutation frequency of 54% (seven of 13) in brainstem GGs. BRAF(V600E) -targeted therapeutics should be a consideration for the high percentage of pediatric brainstem GGs refractory to conventional therapies.
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Affiliation(s)
- Andrew M Donson
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO
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Abstract
Neurophysiologically, central apnea is due to a temporary failure in the pontomedullary pacemaker generating breathing rhythm. As a polysomnographic finding, central apneas occur in many pathophysiological conditions. Depending on the cause or mechanism, central apneas may not be clinically significant, for example, those that occur normally at sleep onset. In contrast, central apneas occur in a number of disorders and result in pathophysiological consequences. Central apneas occur commonly in high-altitude sojourn, disrupt sleep, and cause desaturation. Central sleep apnea also occurs in number of disorders across all age groups and both genders. Common causes of central sleep apnea in adults are congestive heart failure and chronic use of opioids to treat pain. Under such circumstances, diagnosis and treatment of central sleep apnea may improve quality of life, morbidity, and perhaps mortality. The mechanisms of central sleep apnea have been best studied in congestive heart failure and hypoxic conditions when there is increased CO2 sensitivity below eupnea resulting in lowering eupneic PCO2 below apneic threshold causing cessation of breathing until the PCO2 rises above the apneic threshold when breathing resumes. In many other disorders, the mechanism of central sleep apnea (CSA) remains to be investigated.
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Affiliation(s)
- S Javaheri
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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Lee A, Chen ML, Abeshaus S, Poliakov A, Ojemann JG. Posterior fossa tumors and their impact on sleep and ventilatory control: A clinical perspective. Respir Physiol Neurobiol 2013; 189:261-71. [DOI: 10.1016/j.resp.2013.05.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 04/23/2013] [Accepted: 05/22/2013] [Indexed: 11/28/2022]
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Chan MH, Kleinschmidt-DeMasters BK, Donson AM, Birks DK, Foreman NK, Rush SZ. Pediatric brainstem gangliogliomas show overexpression of neuropeptide prepronociceptin (PNOC) by microarray and immunohistochemistry. Pediatr Blood Cancer 2012; 59:1173-9. [PMID: 22706982 PMCID: PMC4681521 DOI: 10.1002/pbc.24232] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 05/22/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Gangliogliomas (GGs) primary to brainstem are rare, with the overwhelming majority of GGs occurring in supratentorial, especially temporal lobe, locations. A less favorable prognosis exists for brainstem GGs, despite their usually identical WHO grade I status. Few large clinical series, and limited biological information, exists on these tumors, especially gene expression. PROCEDURE Seven pediatric brainstem GGs, all with classic histological features, seen at our institution since 2000 were identified. Frozen section material was available for gene expression microarray profiling from five of seven brainstem GGs and compared with that from three non-brainstem pediatric GGs. RESULTS Significant upregulation of a number of genes was identified, most of which were involved in pathways of neural signaling, embryonic development, and pattern specification in pediatric brainstem GGs compared to non-brainstem. The single largest upregulated gene was a 256-fold increase in the expression of the neuropeptide prepronociceptin (PNOC); the protein product of this gene has been implicated in neuronal growth. Overexpression was validated by Western blot and by immunohistochemistry (IHC). Strong IHC expression of PNOC was seen in neoplastic neurons of 7/7 brainstem GGs, but was significantly weaker in non-brainstem GGs, and completely negative in normal pediatric autopsy brainstem controls. CONCLUSIONS PNOC IHC was often superior to IHC for NeuN, synaptophysin, or neurofilament for highlighting neoplastic neurons.
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Affiliation(s)
- Mike H. Chan
- Department of Neuro-oncology, Children’s Hospital Colorado, Aurora, Colorado, 13123 East 16th Avenue, Aurora, CO 80045
| | - B. K. Kleinschmidt-DeMasters
- Department of Pathology, Anschutz Medical Campus, University of Colorado at Denver, 12800 East 19 Avenue, Aurora, CO 80045, USA,Department of Neurology, Anschutz Medical Campus, University of Colorado at Denver, 12800 East 19 Avenue, Aurora, CO 80045, USA,Department of Neurosurgery, Anschutz Medical Campus, University of Colorado at Denver, 12800 East 19 Avenue, Aurora, CO 80045, USA
| | - Andrew M. Donson
- Department of Neuro-oncology, Children’s Hospital Colorado, Aurora, Colorado, 13123 East 16th Avenue, Aurora, CO 80045
| | - Diane K. Birks
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado at Denver, 12800 East 19 Avenue, Aurora, CO 80045, USA
| | - Nicholas K. Foreman
- Department of Neuro-oncology, Children’s Hospital Colorado, Aurora, Colorado, 13123 East 16th Avenue, Aurora, CO 80045
| | - Sarah Z. Rush
- Department of Neuro-oncology, Children’s Hospital Colorado, Aurora, Colorado, 13123 East 16th Avenue, Aurora, CO 80045
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Afaq T, Magalang UJ, Das AM. An unusual cause of insomnia. Central sleep apnea (CSA). J Clin Sleep Med 2012; 8:623-5. [PMID: 23066378 DOI: 10.5664/jcsm.2176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Tauseef Afaq
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Ohio State University Medical Center, Columbus, OH 43210, USA
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Yang I, Chang EF, Han SJ, Barry JJ, Fang S, Tihan T, Barbaro NM, Parsa AT. Early surgical intervention in adult patients with ganglioglioma is associated with improved clinical seizure outcomes. J Clin Neurosci 2010; 18:29-33. [PMID: 20961765 DOI: 10.1016/j.jocn.2010.05.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Accepted: 05/02/2010] [Indexed: 12/29/2022]
Abstract
Gangliogliomas are rare central nervous system tumors, most commonly affecting children and young adults. Chronic seizure and epilepsy are the most frequent presentation of patients with gangliogliomas. In this report, we review the modern literature regarding the effects of early surgical intervention on the clinical outcome of patients with ganglioglioma. A boolean search of PubMed using key words "ganglioglioma", "adult", "seizure control", "treatment", "surgical intervention", and "observation", alone and in combination was performed. The inclusion criteria for articles were that: (i) clinical outcomes were reported specifically for gangliogliomas; (ii) data were reported for adult patients older than the age of 18 years; (iii) treatment data were included for the treatment of gangliogliomas; and (iv) ganglioglioma was the only pathological diagnosis for the evaluation of the tumor. Data were analyzed as a whole then stratified into two groups: early and late treatment intervention. The query identified a total of 99 articles including 1,089 cases of ganglioglioma meeting our inclusion and exclusion criteria. There was a 55% prevalence of males, representing a statistically significant predilection (51-59%, 95% confidence interval). Seizure control was significantly improved when surgical intervention occurred less than 3 years after symptom onset (78% versus 48%; p = 0.0001). Ganglioglioma in adults represents a rare group of tumors, and our systematic analysis suggests a higher prevalence in males. Our findings also support that an early surgical intervention is significantly associated with improved clinical seizure control.
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Affiliation(s)
- Isaac Yang
- Department of Neurological Surgery, University of California at Los Angeles, Los Angeles, California, USA
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Abstract
Central apnea is caused by temporary failure in the pontomedullary pacemaker generating breathing rhythm, which results in the loss of ventilatory effort, and if it lasts 10 seconds or more it is defined as central apnea. This article reviews current knowledge on central sleep apnea.
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Affiliation(s)
- S Javaheri
- Department of Medicine, University of Cincinnati College of Medicine, 4780 Socialville Fosters Road, Mason, OH 45040, USA.
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Rades D, Zwick L, Leppert J, Bonsanto MM, Tronnier V, Dunst J, Schild SE. The role of postoperative radiotherapy for the treatment of gangliogliomas. Cancer 2010; 116:432-42. [PMID: 19908258 DOI: 10.1002/cncr.24716] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, D-23538 Lubeck, Germany.
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Germ cell tumors of the brainstem: report on two cases with pulmonary complications and a review of the literature. J Neurooncol 2009; 93:405-8. [PMID: 19139823 DOI: 10.1007/s11060-008-9780-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 12/30/2008] [Indexed: 10/21/2022]
Abstract
Intracranial germ cell tumors most commonly present in the pineal and suprasellar regions. Rare cases of brainstem germ cell tumors have been described. Here, we present two cases with brainstem germ cell tumors and review the current literature. The two patients did well, in terms of disease control, but have significant morbidity related to respiratory issues. One patient remains ventilator dependent and the second died from respiratory arrest.
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Matschke J, Laas R. Sudden death due to central alveolar hypoventilation syndrome (Ondine's curse) in a 39-year-old woman with heterotopia of the inferior olive. Am J Forensic Med Pathol 2007; 28:141-4. [PMID: 17525565 DOI: 10.1097/01.paf.0000257396.79742.e9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Failure of automatic involuntary respiration with preservation of voluntary respiratory drive (Ondine's curse) is a rare occurrence which has been reported following a variety of morphologic lesions near respiratory centers in the lower brainstem. We report the case of a 39-year-old woman with a syndrome of fulminant respiratory failure with features of Ondine's curse in whom neuropathologic examination disclosed a preexisting malformation of the lower brainstem, as well as acute local subarachnoid bleeding. Mechanisms in the present case are discussed and a review of similar cases published so far is given. The necessity of sound investigation, including neuropathologic studies in cases of sudden unexplained death, is underlined.
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Affiliation(s)
- Jakob Matschke
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Discolo CM, Akst LM, Schlossberg L, Greene D. Anterior cranial fossa glioblastoma with sleep apnea as the initial manifestation. Am J Otolaryngol 2005; 26:327-9. [PMID: 16137531 DOI: 10.1016/j.amjoto.2005.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Indexed: 11/24/2022]
Abstract
Sleep apnea is well known as a primary medical condition at this time. However, life-threatening diseases in which sleep apnea is the presenting symptom are less well described. The case of a 71-year-old man with a frontal lobe glioblastoma whose primary presenting symptom was sleep apnea is discussed. The relationship of intracranial tumors to sleep apnea symptoms is reviewed.
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Fujisawa H, Yoshida Y, Niida Y, Hasegawa M, Yamashita J. Cyanotic breath-holding spell: a life-threatening complication after radical resection of a cervicomedullary ganglioglioma. Pediatr Neurosurg 2005; 41:93-7. [PMID: 15942280 DOI: 10.1159/000085163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2004] [Accepted: 11/17/2004] [Indexed: 11/19/2022]
Abstract
Cyanotic breath-holding spell is a benign and self-limiting disease of young children but occasionally associated with sudden, unexpected death. The authors report a rare case in a 2-year-old girl with a severe form that started after radical resection of a cervicomedullary ganglioglioma. She was admitted to our hospital because of delayed and unstable gait. Since magnetic resonance imaging showed a cervicomedullary tumor, she underwent a radical resection and histology showed the tumor to be a ganglioglioma. Postoperatively, the function of the lower cranial nerves and cerebellum deteriorated and hemiparesis on the left became apparent, but she returned to the preoperative state in a few months. In addition, mild sleep apnea (Ondine curse) and severe cyanotic breath-holding spells occurred. The former responded to medication but the latter failed and continued several times per day with a rapid onset and progression of hypoxemia, loss of consciousness, sweating and opisthotonos. Five months after the operation, the patient returned home with a portable oxygen saturation monitor equipped with an alarm. This case indicates that cyanotic breath-holding spell, as well as sleep apnea, is critical during the early postoperative period. This is the first report observing that such spells may occur as a complication of radical resection of a cervicomedullary tumor.
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Affiliation(s)
- Hironori Fujisawa
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
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Lanini B, Bianchi R, Romagnoli I, Coli C, Binazzi B, Gigliotti F, Pizzi A, Grippo A, Scano G. Chest wall kinematics in patients with hemiplegia. Am J Respir Crit Care Med 2003; 168:109-13. [PMID: 12714347 DOI: 10.1164/rccm.200207-745oc] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Owing to difficulties in measuring ventilation symmetry, good evidence of different right/left respiratory movements has not yet been provided. We investigated VT differences between paretic and healthy sides during quiet breathing, voluntary hyperventilation, and hypercapnic stimulation in patients with hemiparesis. We studied eight patients with hemiparesis and nine normal sex- and age-matched subjects. Right- and left-sided VT was reconstructed using optoelectronic plethysmography. In control subjects, no asymmetry was found in the study conditions. VTs of paretic and healthy sides were similar during quiet breathing, but paretic VT was lower during voluntary hyperventilation in six patients and higher during hypercapnic stimulation in eight patients (p = 0.02). The ventilatory response to hypercapnic stimulation was higher on the paretic than on the healthy side (p = 0.012). In conclusion, hemiparetic stroke produces asymmetric ventilation with an increase in carbon dioxide sensitivity and a decrease in voluntary ventilation on the paretic side.
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Affiliation(s)
- Barbara Lanini
- Fondazione Don C. Gnocchi (IRCCS), Via Imprunetana, 124 50020 Pozzolatico, Florence, Italy.
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Tobin MJ. Sleep-disordered breathing, control of breathing, respiratory muscles, pulmonary function testing, nitric oxide, and bronchoscopy in AJRCCM 2000. Am J Respir Crit Care Med 2001; 164:1362-75. [PMID: 11704580 DOI: 10.1164/ajrccm.164.8.2108124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- M J Tobin
- Division of Pulmonary and Critical Care Medicine, Loyola University of Chicago Stritch School of Medicine and Hines Veterans Affairs Hospital, Hines, Illinois 60141, USA.
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