-We report a case showing the association of Moebius syndrome, the use of misoprostol during pregnancy and the development of central congenital alveolar hypoventilation. Pathophysiological aspects of these three diseases are discussed and also the unfavorable prognosis of this association. Moebius syndrome is clinically characterized by congenital nonprogressive facial diplegia and restricted lateral eyes movements. It is usually bilateral and can be followed by other cranial nerves palsy (third, fifth, ninth and tenth). It is usually associated with craniofacial malformation (micrognathia, bifid uvula, cleft palate, epicanthus, external ear) and other malformations (talipes equinovarus, syndactily) 1,2 . The etiology of this syndrome was speculated to be a congenital absence of the motor nuclei of the abducens and facial nerves, but genetical and environmental factors can also be involved. Exposure to infections, alcohol, cocaine, thalidomide or misoprostol were also related in association with Moebius syndrome. It was found in most cases that this syndrome can be the result of infarction of brainstem nuclei during fetal life [3][4][5] . It was also showed in some cases evidences of vascular malformations as capillary hemangiomas in mesencephalic and pontine segments 2 .Congenital central alveolar hypoventilation syndrome (CCAHS) is generally recognized in the first days of life. Symptoms, among others, may include cyanosis, apnea, and sudden respiratory failure. Central hypoventilation is characterized by: hypoventilation during sleep, no or minimal ventilatory and arousal responses to hypercarbia and hypoxia during sleep, nonresponsiveness to respiratory stimulants, unawareness of hypoxia, adequate baseline ventilation during wakefulness, absent or negligible response to hypoxia and hypercarbia while awake 7 . A polysomnography is needed
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