ABSTRACT
An awake patient presented with central neurogenic hyperventilation induced by a cerebral tumor. Corticosteroid therapy and brain irradiation while the patient was anesthetized and respiration controlled under pancuronium-induced respiratory paralysis were followed by tumor regression and resolution of hyperventilation. Recurrence of tumor 6 weeks later was not accompanied by recurrence of hyperventilation. Cytologic study of cerebrospinal fluid revealed B-cell lymphoma. This patient brings to 10 the number of cases recorded with tumor-induced central neurogenic hyperventilation. Five of the eight patients with known tumor histology had a primary cerebral lymphoma, a rare neoplasm that comprises only 1% of all intracranial neoplasms. The disproportionately high frequency of central neurogenic hyperventilation in patients with cerebral lymphoma has therapeutic implications that are briefly reviewed.
Subject(s)
Brain Neoplasms/complications , Brain/physiopathology , Hyperventilation/etiology , Lymphoma/complications , Adrenal Cortex Hormones/therapeutic use , Brain/diagnostic imaging , Brain Neoplasms/physiopathology , Brain Neoplasms/radiotherapy , Combined Modality Therapy , Diaphragm/drug effects , Female , Humans , Hyperventilation/physiopathology , Lymphoma/physiopathology , Lymphoma/radiotherapy , Middle Aged , Pancuronium/therapeutic use , Tomography, X-Ray ComputedABSTRACT
The effects of vecuronium 0.1 mg kg-1 on intracranial pressure, heart rate and arterial pressure were evaluated in 20 anaesthetized patients with intracranial tumours undergoing neurosurgery. Apart from a slight decrease in intracranial pressure (-4.9%; ns) which was most probably the result of a concomitant decrease (-14.9%) in central venous pressure, vecuronium 0.1 mg kg-1 was without effect on either cerebral or systemic haemodynamics.