Case Report: PDF OnlyOndine's Curse in a Patient with Unilateral Medullary and Bilateral Cerebellar InfarctionsHo, Hui-Tzua; Thajeb, Peterusa, c, *; Lin, Ching-Chib Author Information aDepartment of Neurology, Taipei Medical University, Taipei, Taiwan, R.O.C. bDepartment of Chest Medicine, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C. cDivision of Neurology, Taipei Medical University, Taipei, Taiwan, R.O.C. *Correspondence to: Dr. Peterus Thajeb, Department of Neurology, Mackay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei 104, Taiwan, R.O.C. E-mail: [email protected] Received: June 25, 2004 • Accepted: May 3, 2005 Journal of the Chinese Medical Association 68(11):p 531-534, November 2005. | DOI: 10.1016/S1726-4901(09)70088-7 Metrics Abstract Central sleep apnea (CSA), also known as Ondine's curse (OC), is a phenomenon characterized by episodes of repeated apnea during sleep due to disorders of the central nervous system. We report a patient with CSA/OC due to right dorsolateral medullary and bilateral cerebellar infarctions that occurred in the clinical setting of right vertebral artery stenosis. Polysomnography (PSG) showed repeated episodes of absence of nasal cannula flow accompanying cessation of thoracic and abdominal respiratory movements and a decline in blood oxygen saturation. The duration of apnea was as long as 12 seconds. Brain magnetic resonance (MR) images showed acute infarctions involving the right dorsolateral medulla, bilateral cerebellar vermis and paramedian cerebellar hemispheres. MR angiography showed nonvisualization of the right vertebral artery. Transcranial Doppler sonography showed a high resistance flow profile in the right vertebral artery and normal flow patterns in the basilar artery and left vertebral artery. These findings suggest that the medullary and bilateral cerebellar infarcts were caused by stenosis/pseudo-occlusion of the right vertebral artery. Reduced respiratory afferent inputs to the dorsal respiratory group of medullary neurons, the nucleus tractus solitarius and reduced “automatic” components of the respiratory drive may play a role in the development of CSA/OC. © 2005 by Lippincott Williams & Wilkins, Inc.