Periodic breathing and dysphagia associated with a localized lateral medullary infarction

OKU, YOSHITAKA
OKADA, MASAHIRO

¹Department of Physiology, Hyogo College of Medicine, Nishinomiya and ²Department of Neurosurgery, Sumoto Itsuki Hospital, Sumoto, Japan

Correspondence: Yoshitaka Oku, Department of Physiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo Pref. 663-8501, Japan. Email: [email protected]

Received: 7 November 2005; invited to revise: 28 February 2006; revised: 13 March 2006; accepted: 28 April 2006 (Associate Editor: Philip Thompson).

Respirology 13(4):p 608-610, June 2008.

A 77-year-old man experienced sudden onset of dysphagia. An MRI revealed a left lateral medullary infarction. Portable polysomnography showed Cheyne-Stokes-like breathing with marked desaturation (lowest SaO₂ 74%) associated with apnoea. Oxygen administration reduced the apnoea-hypopnoea index from 30.1 to 20.0 per hour. Sustained periodic breathing under normoxaemia suggested that the brainstem lesion, rather than peripheral factors such as prolonged lung-chemoreceptor circulatory delay, was responsible for the abnormal breathing. Polysomnography or overnight SaO₂ monitoring should be considered for patients with dysphagia due to a brainstem lesion, to investigate the possible presence of abnormal breathing.