Central Neurogenic Hyperventilation in a Conscious Patient with Chronic Brain Inflammation

Abstract

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.