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Neurology Publish Ahead of PrintDOI: 10.1212/WNL.0000000000011215
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NEUROLOGY/2020/078048 (R1) - Video NeuroImage
Teaching Video Neuroimage: Cluster breathing in brainstem-sparing
bihemispheric cerebral and cerebellar lesions
Roger M. Meza, MD;1 Hans Schulz, MD;1 Diego Alva, MD;2 Alberto J. Espay
MD, MSc, FAAN.3
Neurology® Published Ahead of Print articles have been peer reviewed and accepted for
publication. This manuscript will be published in its final form after copyediting, page
composition, and review of proofs. Errors that could affect the content may be corrected during
these processes.
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Copyright © 2020 American Academy of Neurology. Unauthorized reproduction of this article is prohibited
Published Ahead of Print on November 16, 2020 as 10.1212/WNL.0000000000011215
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1 Neurology Service, Hospital Regional Docente de Trujillo, Trujillo, Peru.
2Emergency Service, Hospital Regional Docente de Trujillo, Trujillo, Peru.
3 UC Gardner Neuroscience Institute and Gardner Family Center for Parkinson's
Disease and Movement Disorders, Department of Neurology, University of
Cincinnati, USA.
Word count: 106; Title character count (with spaces): 84; Figures: 1; Video:
1; References: 2.
Key words: coma, critical care, respiration, cluster breathing
Corresponding Author:
Alberto J. Espay ([email protected]).
Author contributions:
Dr Meza drafted the manuscript and created the videotape. Drs. Schulz and
Alva evaluated the patient and participated in the review of the manuscript. Dr.
Espay provided critical review of the cases and participated in the review of the
manuscript.
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Study funding
No targeted funding reported.
Disclosures
Dr. Meza report no disclosures.
Dr. Schulz reports no disclosures.
Dr. Alva report no disclosures.
Dr. Espay has received grant support from the NIH and the Michael J Fox
Foundation; personal compensation as a consultant/scientific advisory board
member for Abbvie, Neuroderm, Neurocrine, Amneal, Adamas, Acadia, Acorda,
InTrance, Sunovion, Lundbeck, and USWorldMeds; publishing royalties from
Lippincott Williams & Wilkins, Cambridge University Press, and Springer; and
honoraria from USWorldMeds, Acadia, and Sunovion.
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This 65-year-old comatose man with metastatic melanoma developed rapidly
cycling breathing, with clusters of approximately 10 abdominal excursions within
3 seconds, interspersed by 10 seconds of apnea
(Video,http://links.lww.com/WNL/B276 and Figure), mimicking abdominal
myoclonus. Introduced by Plum and Posner as a respiratory pattern associated
with lesions in the low pons or high medulla,1 cluster breathing can occur
without pontomedullary lesions when respiratory alkalosis accompanies
bihemispheric lesions.2 It differs from the constant tachypnea of central
neurogenic hyperventilation, also associated with respiratory alkalosis, and from
the crescendo-decrescendo breathing pattern of Cheyne-Stokes. Combined
cerebellar and cerebral lesions may suffice to affect brainstem-mediated
respiratory control in the absence of brainstem lesions.
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Video legend
Video. Cluster breathing. Rapid, rhythmic, and shallow breathing cycles were
demonstrated after sedation was removed and ventilatory assistance placed in
CPAP mode using a tracheostomy.
Figure legend
Figure. Brain MRI and monitoring screen. Post-contrast sagittal and coronal
T1-weighted brain MRI demonstrated nodular bihemispheric lesions as well as
contrast-enhancing bilateral cerebellar lesions with no mass effect on the
brainstem. Screenshots of the respiratory monitor at the bottom documented
the cluster-breathing waveforms in the mean airway pressure (Paw, in cm H2O)
and volume (flow, in L/min).
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Appendix 1 Authors
Name Location Contribution
Roger M. Meza,
MD
Hospital Regional
Docente de Trujillo,
Trujillo, Peru
Evaluation of patient;
drafted the manuscript for
intellectual content
Hans Schulz,
MD
Hospital Regional
Docente de Trujillo,
Trujillo, Peru
Major role in the acquisition
of data, review of
manuscript
Diego Alva, MD
Hospital Regional
Docente de Trujillo,
Trujillo, Peru
Major role in the acquisition
of data, review of
manuscript
Alberto J. Espay
MD, MSc
University of
Cincinnati, Ohio,
USA.
Critical review of
manuscript, supervise all
review cycles
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Teaching Slides - http://links.lww.com/WNL/B277
Video - http://links.lww.com/WNL/B276
REFERENCES
1. Plum F, Posner JB. The Diagnosis of Stupor and Coma. New York, NY: Oxford University Press; 1982.
2. Freeman WD, Sen S, Roy TK, Wijdicks EF. Cluster breathing associated with bihemispheric infarction and sparing of the brainstem. Arch Neurol. 2006;63(10):1487-1490.
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Copyright © 2020 American Academy of Neurology. Unauthorized reproduction of this article is prohibited
DOI 10.1212/WNL.0000000000011215 published online November 16, 2020Neurology
Roger M. Meza, Hans Schulz, Diego Alva, et al. cerebral and cerebellar lesions
Teaching Video NeuroImages: Cluster breathing in brainstem-sparing bihemispheric
This information is current as of November 16, 2020
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