Abstract Details

Title CNS Apnea Reversed By Dopamine Agonist

Topic Critical Care/Emergency Neurology/Trauma

Presentation(s) P05 - (-)

Poster/Presentation
Number 206

Objective

Background BACKGROUND: Comatose patients breathe via non-volitional ventilation mechanism mediated by autonomic ventilatory nuclei in medulla. Reports were rare for hypoventilation due to head injury. Neurotransmitter for the nuclei remain undetermined. As parkinsonism onset is preceded by apnea, it is assumed traumatic CNS apnea may be due to depletion of dopamine in the nuclei.

Design/Methods DESIGN/METHODS: Two consecutive full-code cases of sever closed head injury with apnic symptom is presented. MRI ruled out destructive lesion in the brain stem. EEG ruled out nonconvulsive status epilepticus. These patietns had evaluated to rule out pulmonary etiology of apnea and to maintain ventilation support.

Results RESULTS: Case 1: 30 year old man who had closed head injury by motorcycle accident two weeks ago. The patient was unresponsive while eyes open and no voluntary movements in extremities. MRI was non-lesional, and EEG showed FIRDA but no epileptiform dischages. He presented intermittent ataxic breathing and apnea. He received L-dopa/carbidopa 25/100 tid and methylphenidate 10 mg bid. His breathing pattern became stable and rhythmic, and he became able to move the extremities upon verbal commands. Case 2: 27 year old man who had closed head injury by motor vehicle accident. The patient was unresponsive for four weeks. He had no voluntary movements. He had ataxic breathing with frequent apnea. EEG showed diffuse slowing and FIRDA but no epileptiform discharges. MRI showed subdural hygroma in the left frontotemporal head region. He received L-dopa/carbidopa and methilphenidate. In 5 days, he start having increasing voluntary muscle movements. He started following verbal commands and needed no ventiation support.

Conclusions CONCLUSIONS: The improvement of respiration rhythm by L-dopa and methylphenidate combination suggests that central respiratory drives are mediated by dopamine.

Authors/Disclosures
Hisanori Hasegawa, MD PRESENTER	No disclosure on file
Wendy Gabel (Biogen, Inc.)	No disclosure on file

��ɫ��

��ɫ��