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KMID : 1201420160090020152
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Journal of Neurocritical Care
2016 Volume.9 No. 2 p.152 ~ p.157
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Sleep Related Hypoventilation Disorder in the Absence of Medullary Lesion in a Patient with Diffuse Axonal Injury
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Lee Jin-Hyung
Kim Meyung-Kug
Yoo Bong-Goo
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Abstract
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Background: Sleep related hypoventilation disorder (SRHD) is characterized by abnormally elevated PaCO2 during sleep. Damage of the autonomic respiratory center located in the medulla is generally considered to cause SRHD. Here, we report a case of SRHD in the absence of a medullary lesion.
Case Report: A 29-year-old man consulted the neurology department for intermittent hypopnea during sleep. Two months ago, he had suffered a traumatic pneumothorax, spleen injury, diaphragm rupture, cerebral hemorrhage, and diffuse axonal injury due to a car accident. He underwent a tracheostomy, and had been in a persistent vegetative state, but self-respiration was possible. During conservative therapy, he had bouts of intermittent hypopnea when asleep, which disappeared by stimulation. There were no medullary lesions in the brain images. He was treated with a portable home-ventilator.
Conclusions: In patients with traumatic brain injury, various respiration abnormalities may arise. Clinicians should observe for the possibility of occurrence of SRHD, even though there is no medullary lesion.
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KEYWORD
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Sleep, Hypoventilation, Diffuse axonal injury, Medulla oblongata
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