Central Hyperventilation in a Patient with Recurrent Acute Lymphoblastic Leukemia

Introduction

Central hyperventilation (CH) is a respiratory pattern commonly observed in moribund patients due to advanced dysfunction of the respiratory centers in the brain stem. Hyperventilation which is not secondary to cardiorespiratory, metabolic or toxic disorders should lead the clinical suspicion to CH, which is defined as progressive tachypnea while awake and during sleep, accompanied by hypocapnia and respiratory alkalosis (Ledet et al., Neurology 2014; 82 (12): 1099–1100, Lange et al., J Neurol Neurosurg Psychiatry 1965; 28 (4): 317–319, Shahar et al., Pediatr Neurol 2004; 30 (4): 287–290). It is suspected to occur due to disruption of cortical inhibitory effects on the medullary respiratory centers, caused by various lesions of the cortex, the midbrain and the brainstem (Plum at al., AMA Arch Neurol Psychiatry 1959; 81 (5): 535–549, Gaviani et al., Neurology 2005; 64 (1): 166–167). CH has rarely been observed in conscious patients and in those cases it appeared mostly in the context of malignancies, involving the central nervous system (CNS). In adults CH seems to occur more frequently in association with cerebral lymphomas (Pauzner et al., Arch Neurol 1989; 46 (5): 510–512, Shibata et al., J Neurosurg 1992; 76 (4): 696–700). In children, data for this rare neurologic manifestation have not been reported in patients with hematologic malignancies. We describe a case of a child with an isolated CNS relapse of acute lymphoblastic leukemia (ALL) whose single presentation was CH.