Unilateral phrenic nerve stimulation for neurogenic hypoventilation in Arnold Chiari malformation

Abstract

A 25-year-old patient presented with progressive quadriparesis of 2 months duration with shallow breathing. Magnetic resonance imaging (MRI) was suggestive of Arnold-Chiari malformation type I with extensive syringomyelia and bulbia [ Figure 1]. Foramen magnum decompression with duraplasty was performed. Post-operatively, neurological recovery was uneventful except for prolonged ventilator support and delayed weaning over 2 weeks. At the time of discharge, patient was ambulant with support, breathing spontaneously with normal arterial blood gas (ABG) results.Patient was readmitted to the emergency department after 1 month with a history of seizures, altered sensorium of few hours' duration and shallow breathing. His ABG was suggestive of severe respiratory acidosis (pCO 2 91 mmHg, pO 2 71.2 mmHg, pH 7.012). Following elective ventilation, the blood gases were normalized and patient regained sensorium. Detailed history given by relatives suggested very few respiratory movements during sleep with progressive drowsiness during daytime and gradual unconsciousness. A repeat MRI revealed complete resolution of syrinx with decompressed foramen magnum [ Figure 2]. Tracheostomy was performed to facilitate early weaning. Continuous monitoring revealed a trend of significant reduction in respiratory rate, progressive buildup of end-tidal CO 2 and deterioration of blood gases during sleep, which

Diaphragm Pacing (Phrenic Nerve Stimulation) in a High Cervical Spinal Cord Injury in Quadriplegic Patient

“…Very few centers in India have attempted in pacing the phrenic nerve and the diaphragm for various indications, including sleep apnea and amyotrophic lateral sclerosis. 5,6 The high cost factor, availability of systems, and the long-term care of the patients in and out of the medical setup will be the real challenge in India apart from the acceptability factor of this scientific technique. Indian medical system is ready for diaphragm pacing and can provide quality care.…”