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Transient Acquired Hypoventilation Syndrome Secondary to Uncal Herniation Successfully Treated with Bilevel Non-Invasive Positive Pressure Ventilation
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A6878 - Transient Acquired Hypoventilation Syndrome Secondary to Uncal Herniation Successfully Treated with Bilevel Non-Invasive Positive Pressure Ventilation
Author Block: J. Xu1, L. Hou1, J. Stoll1, W. Khan2; 1Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States, 2University Medical Center of Princeton, Plainsboro, NJ, United States.
Introduction Central hypoventilation syndrome (CHS) is characterized by the disruption of integration signals in ventilatory control system resulting in hypoventilation, hypoxemia and hypercapnia. Brainstem injury due to ischemia, inflammation, or trauma can result in acquired central hypoventilation syndrome (ACHS). ACHS due to uncal herniation usually results in long term hypoventilation. The cornerstone of management includes non-invasive positive pressure ventilation (NIPPV). Transient ACHS due to uncal herniation is rare, and management strategies with NIPPV are lacking. We report a case of transient ACHS due to uncal herniation, which was successfully treated with bilevel non-invasive positive pressure ventilation.
Case A 48-year-old male presented to the emergency room for recurrent syncope. He became acutely unresponsive. Physical exam at that time was notable for pupils which became fixed and dilated. Emergent computed tomography of the head revealed a ventricular colloid cyst with hydrocephalus and uncal herniation. Emergent bed-side bilateral external ventricular drains were placed in the emergency room. He was noted to be apneic and bradypnic on mechanical ventilation. The low minute ventilation persisted after liberation from mechanical ventilation. The hypoventilation was managed with bilevel NIPPV intermittently during wakefulness and throughout sleep times. Ventilation was monitored by non-invasive respiratory rate, end-tidal carbon dioxide detection, and arterial blood gas (ABG) sampling. The patient made a functional recovery and hypoventilation resolved after three to four days. ABG at that time revealed PaCO 35 mm Hg on room air. NIPPV was discontinued. He ultimately underwent surgical resection of the colloid cyst.
Discussion ACHS is usually due to brainstem lesions or insults affecting respiratory control centers. ACHS due to uncal herniation is usually long-term. Transient ACHS due to uncal herniation is rare and management strategies for hypoventilation with NIPPV are lacking. In this case, the transient ACHS was managed successfully with bilevel NIPPV intermittently during wakefulness and throughout sleep periods. We believe that further studies regarding the role of NIPPV during management of transient ACHS may be helpful.
Author Block: J. Xu1, L. Hou1, J. Stoll1, W. Khan2; 1Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States, 2University Medical Center of Princeton, Plainsboro, NJ, United States.
Introduction Central hypoventilation syndrome (CHS) is characterized by the disruption of integration signals in ventilatory control system resulting in hypoventilation, hypoxemia and hypercapnia. Brainstem injury due to ischemia, inflammation, or trauma can result in acquired central hypoventilation syndrome (ACHS). ACHS due to uncal herniation usually results in long term hypoventilation. The cornerstone of management includes non-invasive positive pressure ventilation (NIPPV). Transient ACHS due to uncal herniation is rare, and management strategies with NIPPV are lacking. We report a case of transient ACHS due to uncal herniation, which was successfully treated with bilevel non-invasive positive pressure ventilation.
Case A 48-year-old male presented to the emergency room for recurrent syncope. He became acutely unresponsive. Physical exam at that time was notable for pupils which became fixed and dilated. Emergent computed tomography of the head revealed a ventricular colloid cyst with hydrocephalus and uncal herniation. Emergent bed-side bilateral external ventricular drains were placed in the emergency room. He was noted to be apneic and bradypnic on mechanical ventilation. The low minute ventilation persisted after liberation from mechanical ventilation. The hypoventilation was managed with bilevel NIPPV intermittently during wakefulness and throughout sleep times. Ventilation was monitored by non-invasive respiratory rate, end-tidal carbon dioxide detection, and arterial blood gas (ABG) sampling. The patient made a functional recovery and hypoventilation resolved after three to four days. ABG at that time revealed PaCO 35 mm Hg on room air. NIPPV was discontinued. He ultimately underwent surgical resection of the colloid cyst.
Discussion ACHS is usually due to brainstem lesions or insults affecting respiratory control centers. ACHS due to uncal herniation is usually long-term. Transient ACHS due to uncal herniation is rare and management strategies for hypoventilation with NIPPV are lacking. In this case, the transient ACHS was managed successfully with bilevel NIPPV intermittently during wakefulness and throughout sleep periods. We believe that further studies regarding the role of NIPPV during management of transient ACHS may be helpful.
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