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Vol. 35. Issue 11.
Pages 560-563 (December 1999)
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Vol. 35. Issue 11.
Pages 560-563 (December 1999)
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Insuficiencia respiratoria aguda como primera manifestación de lesiones del tronco cerebral
Acute respiratory insuffíciency as the fírst sign of cerebral brainstem lesión
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G. Juan1, M. Ramón, M.A. Ciscar, B. García, T. Lloret
Servicios de Neumología y Neurología. Facultad de Medicina de Valencia. Valencia
M.A. Cervelló*, J. Marín**
* Servicios de Neumología y Neurología. Hospital General Universitario. Facultad de Medicina de Valencia. Valencia
** Servicios de Neumología y Neurología. Hospital Clínico Universitario. Facultad de Medicina de Valencia. Valencia
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Presentamos tres pacientes con diferentes lesiones en tronco cerebral (angioma bulbar, infarto bulbar y malformación de Arnold-Chiari) que debutaron como insuficiencia respiratoria aguda. En los tres casos las otras manifestaciones neurológicas que presentaban pasaron desapercibidas en un primer momento. La insuficiencia respiratoria empeoraba notablemente durante el sueño hasta ser necesaria la ventilación mecánica o producir la muerte del paciente (maldición de Ondina). El paciente con angioma bulbar se mantiene con ventilación asistida vía nasal únicamente por la noche con buena calidad de vida.

Se concluye: a) la necesidad de investigar en el sistema nervioso central como causa de insuficiencia respiratoria global con pulmones normales; b) la conveniencia de estudiar el control de la respiración, sobre todo por la noche (polisomnografía) a los pacientes con lesiones del tronco cerebral, y c) aunque en vigilia mantienen una ventilación adecuada, por la noche pueden necesitar ventilación mecánica.

Palabras clave:
Insuficiencia respiratoria aguda extrapulmonar
Lesiones cíe tronco cerebral con insuficiencia respiratoria
Maldición de Ondina

We describe three patients with different brainstem lesions (bulbar angioma, bulbar infarct, and Arnold-Chiari malformation) who debuted with acute respiratory insuffíciency. Other neurological manifestations had gone unobserved in all three cases. Respiratory insuffíciency worsened notably during sieep to the point that mechanical ventilation was required or death occurred (Ondine s curse). The patient with a bulbar angioma is stable with oniy assisted ventilation by a nasal route at night, with good quality of life.

Our conclusions are that: a) central nervous system anomalies need to be investigated as possible causes of respiratory insufficiency when lungs are normal; b) the respiratory control of patients with brainstem lesions shouid be studied, particularly at night (polysomnography), and c) even when awake-state ventilation is adequate, nighttime assisted ventilation may be required.

Key words:
Acule extrapiilinonury respiratory insiifficiency
Brainstem lesions with respiratory insuffíciency
Ondina’s curse
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Copyright © 1999. Sociedad Española de Neumología y Cirugía Torácica
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