Central alveolar hypoventilation syndrome (CAHS) is a rare and potentially fatal condition. However, respiratory care for patients with CAHS caused by lateral medullary
infarction (CAHS-LMI) remains an important unsolved problem. We describe 2 patients with CAHS-LMI and review the case reports for 17 previously described patients. Patient 1 was a 78-year-old man who was referred to our hospital because of
dizziness. After admission,
Wallenberg syndrome developed. Magnetic resonance imaging showed left LMI. He had
hypercapnia and
respiratory acidosis the next afternoon and temporarily received
mechanical ventilation. A
tracheotomy was performed on the 12th hospital day, and the patient was weaned from the
ventilator on the 18th hospital day. Patient 2 was 72-year-old man who was referred to our hospital because of
dizziness and gait disturbance.
Wallenberg syndrome was diagnosed after admission, and magnetic resonance imaging showed right LMI. His consciousness deteriorated, and
hypercapnia developed on the ninth hospital day. The patient received ventilatory support, and a
tracheotomy was performed on the 12th hospital day. He was weaned from the
ventilator by the 16th hospital day. Consistent with our findings, most previously reported cases of CAHS-LMI were initially associated with mild symptoms, which subsequently worsened. Five of the 19 patients (26.3%) died within 1 month after onset, and 7 patients (36.8%) died within 1 year.
Tracheotomy was performed in 12 patients, 2 of whom died 1 month after onset (16.7%); another patient died of
chronic renal failure after 2 years.
Tracheotomy seemed to be an effective procedure in patients with CAHS-LMI. We speculate that
tracheotomy assists alveolar ventilation by reducing dead space ventilation. Closure of the
tracheotomy should, therefore, be avoided in patients with CAHS-LMI, even if respiratory status is good.