Central Neurogenic Hyperventilation in a Conscious Patient with Chronic Brain Inflammation

慢性大腦發炎誘發之中樞神經性換氣過度

陳奕仁(Yi-Jen Chen) ； 宋昇峰(Sheng-Feng Sung) ； 許永居(Yung-Chu Hsu)

《內科學誌》 24卷4期 (2013/08) Pp. 328-333

https://doi.org/10.6314/JIMT.2013.24(4).11

摘要

內科急診常會遇見過度換氣症候群的病患，其發生的病因很多，中樞神經性病變因罕見而不易列於起始的鑑別診斷中。於我們所報告的這位53歲男性病患，當他因呼吸會喘求診時，意識清楚且尚能工作。他的理學檢查顯示呼吸聲音清澈且心跳規則無雜音，動脈血分析報告顯示極度呼吸性鹼中毒PH：7.637，PaCO2：8.2 mmHg，PaO2：126.7 mmHg，HCO3^-：8.6 mmol/L，BE：-7.3 mmol/L and O2Sat: 99.1%。胸部電腦斷層檢查未發現明顯病兆。神經學檢查發現其眼睛向上看有困難，腦部核磁共振檢查顯示有大腦病變，經腦部切片檢查顯示其有慢性發炎狀態。在處理過度換氣症候群的病患，對於極度呼吸性鹼中毒又有代謝性代償時，適當的神經學檢查將有助於發現潛在的中樞性病兆。

並列摘要

Central neurogenic hyperventilation (CNH) is a rare and easily forgotten diagnosis. A 53-year-old male patient presented with dyspnea for the past 1 month. His consciousness was clear and had bilateral upward gazing palsy. The arterial blood gas analysis showed severe respiratory alkalosis. Brain magnetic resonance imaging revealed symmetric hyperintense lesions involving the midbrain and the area surrounding the fourth ventricle. A brain biopsy showed gliosis and chronic inflammation. CNH results from an uninhibited respiratory drive due to pons or medulla disorders, and a conscious patient can mislead the initial judgment of the physician. However, severe respiratory alkalosis and persistent nocturnal dyspnea should raise the clinical suspicion of CNH. Chronic brain inflammation with CNH has seldom been reported in the literature. This case provides another pathological possibility of CNH.

並列關鍵字

Central neurogenic hyperventilation ； Inflammation ； Conscious