Ventilatory management and weaning in a patient with central hypoventilation caused by a brainstem cavernoma

Gs, Rao; Ramesh, VJ; Lalla, RK

doi:10.1111/j.1399-6576.2005.00795.x

Cited by 11 publications

(2 citation statements)

References 10 publications

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“…The surgical indications were as follows: 1) multiple hemorrhages (≥ 2), 4,32,54,59 lesion size (lesion equivalent diameter) ≥ 2 cm, and serious or progressive neurological deficit; 13,46,49,53,59,69 2) lesion location in the medulla oblongata; 39,60,69 3) acute or subacute hemorrhage with a significant mass effect; and 4) exophytic lesion or one abutting the pial surface accessible via the "safe entry zones." 32,46,49,54,59,65,69 The lesion size was evaluated as the lesion equivalent diameter (abc) 1/3 , where a, b, and c represent the 3 diameter measurements obtained, respectively, on axial, sagittal, and coronal MR images.…”

Section: Hemorrhage Definition and Surgical Indicationsmentioning

confidence: 99%

Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations

Yang

Hao

et al. 2013

JNS

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Object The aim of this study was to evaluate the pre- and postoperative rehemorrhage risk, neurological function outcome, and prognostic factors of surgically treated brainstem cavernous malformations (CMs) with long-term follow-up. Methods The authors conducted a retrospective review of the clinical data from 242 patients with brainstem CMs that were surgically treated between 1999 and 2010. Patient charts, imaging findings, and outcomes were examined. Results The study included 242 patients, with a male-to-female ratio of 1.3 and mean age of 32.6 years. The mean modified Rankin Scale scores on admission, at discharge, at 3 and 6 months after surgery, and at recent evaluation were 2.2, 2.6, 2.3, 1.8, and 1.5, respectively. The preoperative calculated annual hemorrhage and rehemorrhage rates were 5.0% and 60.9%, respectively. The complete resection rate was 95%. Surgical morbidity occurred in 112 patients (46.3%). Eighty-five patients (35.1%) demonstrated worsened condition immediately after surgery; 34 (41.0%) and 51 (61.4%) of these patients recovered to their baseline level within 3 and 6 months after surgery, respectively. At a mean follow-up of 89.4 months, the patients' condition had improved in 147 cases (60.7%), was unchanged in 70 cases (28.9%), and had worsened in 25 cases (10.3%). A total of 8 hemorrhages occurred in 6 patients, and the postoperative annual hemorrhage rate was 0.4%. Permanent morbidity remained in 65 patients (26.9%). The adverse factors for preoperative rehemorrhage were age ≥ 50 years, size ≥ 2 cm, and perilesional edema. The risk factors for postoperative hemorrhage were developmental venous anomaly and incomplete resection. The independent adverse factors for long-term outcome were increased age, multiple hemorrhages, ventral-seated lesions, and poor preoperative status. Favorable, complete improvement in the postoperative deficits over time was correlated with good preoperative neurological function and continuing improvement thereafter. Conclusions Favorable long-term outcomes and significantly low postoperative annual hemorrhage rates were achieved via surgery. Total resection should be attempted with an aim of minimal injury to neurological function; however, postoperative deficits can improve during the postoperative course. Close follow-up with radiological examination is proposed for patients with adverse factors predictive of rehemorrhage.

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Section: Hemorrhage Definition and Surgical Indicationsmentioning

confidence: 99%

Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations

Yang

Hao

et al. 2013

JNS

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“…TBIs in multi trauma patients can cause dis-ruption of the central respiratory system leading to prolonged mechanical ventilation and increased stay in the ICU [3,4]. More specifically, individuals with TBIs develop central alveolar hypoventilation (CAH) disorders, which can be a result of conditions such as ischemia, tumors, neurodegenerative disorders, infection, and trauma [5][6][7][8]. CAH has been found to arise from disruptions affecting the sensors, the central controller, or the integration of neurologic signals within the central respiratory centers in the pons and medulla [3].…”

Section: Introductionmentioning

confidence: 99%

Novel Treatment of Ventilator Dyssynchrony From Central Alveolar Hypoventilation Syndrome Utilizing Scheduled 5-Hydroxytryptamine-3 Receptor Antagonist

Malkoc¹,

Stading²,

Wong³

et al. 2022

J Med Cases

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Traumatic brain injury (TBI) occurs in a large percentage of surgical trauma patients and is one of the leading causes of death amongst young teens and adults. Furthermore, individuals with TBIs often require mechanical ventilation and admission to the intensive care unit. As a result of their TBIs, these patients can develop central alveolar hypoventilation (CAH) secondary to disruptions in neuromodulatory respiratory brainstem control and neural signal initiation and integration. Prior studies have primarily focused their attention on treatment of congenital disorders of CAH, and limited research is available on intubated trauma patients who have signs of ventilator dyssynchrony. Current case reports and animal studies have suggested that noradrenergic and specific serotonergic medications are able to target specific neurologic pathways in the respiratory circuit and induce ventilator synchrony. This case series describes the clinical course of TBI patients treated for ventilator dyssynchrony secondary to CAH with a daily scheduled 5-hydroxytryptamine-3 (5-HT3) receptor antagonist. All patients were ultimately extubated and discharged from the hospital.

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Dysautonomia and Sleep Dysfunction in Pediatric Practice

Kotagal

2021

Autonomic Nervous System and Sleep

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Ventilatory management and weaning in a patient with central hypoventilation caused by a brainstem cavernoma

Cited by 11 publications

References 10 publications

Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations

Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations

Novel Treatment of Ventilator Dyssynchrony From Central Alveolar Hypoventilation Syndrome Utilizing Scheduled 5-Hydroxytryptamine-3 Receptor Antagonist

Dysautonomia and Sleep Dysfunction in Pediatric Practice

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