1/50. Chiari malformation and sleep-disordered breathing: a review of diagnostic and management issues.Chiari Malformation (CM) encompasses several patterns of congenital or acquired cerebellar herniation through the foramen magnum. This may result in brain-stem compression that impacts control of breathing and is associated with obstructive and central apneas. A high clinical suspicion for sleep-disordered breathing is needed in the care of such patients after as well as before corrective surgery. To introduce a review of CM with a focus on the relevance to sleep medicine, we present a case of a 13-year-old female who was diagnosed with CM Type 1 in the course of an evaluation of symptomatic central sleep apnea. After initial improvement following surgery there was recurrence of brain-stem compression. The only clinical expression of which was polysomnographically evident recurrence of sleep apnea.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
2/50. Upper and lower airway compromise in the Apert syndrome.Both upper and lower airway compromise may be responsible for early death in some patients with the Apert syndrome. We report on two and review six cases with complete or partial cartilage sleeve abnormalities of the trachea. Possible mechanisms include tracheal stenosis and/or lack of tracheal distensibility which may result in respiratory inefficiency, inability to clear secretions, and/or increased liability to surface injury from tracheal suctioning. Upper airway compromise, consisting of obstructive sleep apnea and cor pulmonale, may result from reduced nasopharyngeal and oropharyngeal dimensions in the Apert craniofacial configuration.- - - - - - - - - - ranking = 0.0088438248859801keywords = injury (Clic here for more details about this article) |
3/50. Improvement of cheyne-stokes respiration, central sleep apnea and congestive heart failure by noninvasive bilevel positive pressure and medical treatment.A 57-year-old man was admitted with dyspnea. Clinical evaluation revealed atrial fibrillation and congestive heart failure (CHF). Standard medical therapy of CHF failed to completely improve the dyspnea and polysomnography revealed cheyne-stokes respiration with central sleep apnea (CSR-CSA). He was equipped with noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (BiPAP). The combined therapy of medical treatment of the CHF and administration of NPPV with BiPAP reduced the CSR-CSA. This regimen resulted in marked improvement of cardiac function, evaluated by echocardiography, and reduction of plasma concentration of brain natriuretic peptide. After the patient recovered from CHF and was discharged from hospital, he continued to use NPPV with BiPAP at home. In patients with CHF, it is important to be aware of sleep-related breathing disorders because treatment will not only improve the hypoxemia, but also the cardiac dysfunction.- - - - - - - - - - ranking = 0.5keywords = brain (Clic here for more details about this article) |
4/50. Lethal obesity associated with sodium valproate in a brain-injured patient.A 34-year-old man developed posttraumatic epilepsy and a disinhibited orbitofrontal syndrome following severe head trauma at age 22. After an 11-year prison term marked by repeated impulsive aggression, he was transferred to a state psychiatric hospital. Replacement of phenytoin by valproic acid resulted in a 100-lb weight gain, exacerbation of sleep apnea, and right heart failure. Despite replacement of valproate with topiramate, he died of a cardiorespiratory arrest during a seizure. This case illustrates the potential risks associated with valproate therapy in the obese brain-damaged population.- - - - - - - - - - ranking = 2.5keywords = brain (Clic here for more details about this article) |
5/50. Axial herniation with brain stem deformity as a cause of sleep apnea.A patient with an intracerebral hematoma and associated edema in the high right hemisphere parasagittal convexity had several episodes of apnea at night and during the day when she was asleep. On computed tomography (CT) scan, the hematoma demonstrated no evidence of brainstem compression. Sagittal magnetic resonance image (MRI), revealed the hematoma and edema mass resulted in central herniation with axial deformity of the brainstem. This is believed to be the cause of the apneic episodes. Treatment with mannitol and steroids promptly relieved the symptom.- - - - - - - - - - ranking = 3keywords = brain (Clic here for more details about this article) |
6/50. sleep-disordered breathing in mobius syndrome.mobius syndrome is a complex neurologic disorder characterized by congenital bilateral facial paralysis associated with lateral gaze paralysis. The syndrome has variable manifestations and several variants, some with somatic stigmata. In 1990, mobius syndrome is conceptualized as a spectrum of clinical caudal brain-stem signs. Some deficits are manifested by laryngeal paralysis and aspiration. sleep-disordered breathing syndromes have not been previously reported in association with mobius syndrome. We report two children with Mobius syndrome and sleep-disordered breathing. Based on known pathologic findings and clinical manifestations, we believe that sleep-disordered breathing may be a common complication of mobius syndrome and should be sought, since potential outcomes of such complications include serious morbidity.- - - - - - - - - - ranking = 0.5keywords = brain (Clic here for more details about this article) |
7/50. Drivers with untreated sleep apnea. A cause of death and serious injury.Three patients with untreated sleep apnea fell asleep while driving and caused serious automobile accidents. One person died, another became permanently paraplegic, and the three patients with sleep apnea were seriously injured in these crashes. This sequela of sleep apnea is not surprising, since subjects with sleep apnea may be poor drivers with a high accident rate and a high incidence of "near-miss" vehicular incidents. Because drivers with untreated sleep apnea may cause a large number of preventable automobile accidents, physicians have specific duties involving these drivers. First, physicians must try to identify impaired drivers with sleep apnea before they have an accident; routinely asking patients about loud snoring and hypersomnolence may help identify these impaired drivers. Second, physicians must consider the diagnosis of sleep apnea when examining patients who fall asleep while driving. Next, physicians must warn their patients with sleep apnea about the risks of driving with untreated sleep apnea. Finally, physicians must treat any seriously impaired driver with sleep apnea and keep these patients from driving until they can receive successful treatment.- - - - - - - - - - ranking = 0.03537529954392keywords = injury (Clic here for more details about this article) |
8/50. Obstructive disordered breathing during sleep in patients with spinal cord injury.Little is known about respiration and sleep in spinal cord injured (SCI) patients, and yet they frequently have complaints related to sleep. Four SCI patients with various sleep complaints were evaluated with nocturnal polysomnography. All 4 had evidence of obstructive sleep apnea (disordered breathing). These findings suggest that obstructive sleep apnea may be contributing to disruptive sleep in SCI patients and may be responsible for many of their daytime symptoms.- - - - - - - - - - ranking = 0.03537529954392keywords = injury (Clic here for more details about this article) |
9/50. Dominantly inherited apathy, central hypoventilation, and Parkinson's syndrome: clinical, biochemical, and neuropathologic studies of 2 new cases.We describe 2 new patients from a family in which 10 persons in 3 successive generations had a dominant neuropsychiatric disorder characterized by apathy, central hypoventilation, and parkinsonism. Neuropathologically, both patients showed severe neuronal loss and reactive gliosis in the substantia nigra. Neurochemical studies showed a marked depletion of dopamine in substantia nigra, putamen, and caudate nucleus, as well as reduction in serotonin content in the substantia nigra. Glutamate contents were low in frontal cortex and thalamus, and gamma-aminobutyric acid (GABA) contents were low in thalamus and substantia nigra of both patients. In addition, phosphoethanolamine contents were reduced in all brain regions of both patients, especially in the substantia nigra. One patient with severe symptoms had low levels of homovanillic acid, 5-hydroxyindoleacetic acid, and GABA in his CSF repeatedly for 3 years before death (aged 58), while the 2nd patient died (aged 51) of an unrelated cause before developing any symptoms of the familial disorder. Because brain deficiencies of multiple neurotransmitters appear to be involved, this disorder is unlikely to respond to treatment; however, neurochemical studies of CSF may make presymptomatic diagnosis feasible.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
10/50. Lipomas of the mesencephalic tectum and rostral pons associated with sleep apnea syndrome.Two patients with mixed sleep apnea and autopsy-documented lipomas of the mesencephalic tectum and rostral pons are presented. Microscopically, the locus ceruleus was unilaterally invaded by a tumor in one case and may have been compressed in the other. adipocytes and fibrous tissue were present adjacent to pial surfaces and around small blood vessels within the parenchyma. There was prominent astrogliosis in the adjacent neuropil. Although respiratory control is a complex, multifocal phenomena, these findings raise the possibility that the locus ceruleus or adjacent brain stem regions may be affected in some instances of sleep apnea.- - - - - - - - - - ranking = 0.5keywords = brain (Clic here for more details about this article) |
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