Ondine's curse in association with diabetes insipidus following transient vertebrobasilar ischemia

Ischemic lesions of the brainstem can lead to complex neurologic deficits. Failure of the automatic control of ventilation (Ondine's curse syndrome) i s a possible but rare syndrome following localized brainstem dysfunction. W e report on a 49-year-old man with intermittent bradycardia, cranial nerves ' dysfunctions and a slight right-sided hemiparesis. an acute brainstem isc hemia was diagnosed and treated immediately with high-dose heparin. Cerebra l angiography revealed a proximal occlusion of the left vertebral artery bu t a normal right vertebral artery and a hyperplastic right posterior inferi or cerebellar artery. Cranial Computed Tomography and MRI scan demonstrated multiple ischemic lesions in the posterior circulation. During a 4-week tr eatment course the patient underwent six episodes of acute seven hypoxia an d hypercapnia requiring orotracheal intubation twice and manual ventilation by air mask over a few minutes for four times after a tracheostomy had bee n performed. Twice a short-term episode of hypothalamic Diabetes insipidus was observed following hypoventilation. We conclude that both Ondine's curs e syndrome and diabetes insipidus were due to transient vertebrobasilar isc hemia. (C) 1999 Elsevier Science B.V. All rights reserved.