Question

Following respiratory breathing pattern is seen in which lesion?

• A. Midbrain
• B. Pons
• C. Medulla
• D. Cortex

Hint:

Respiratory Localization Table:
$\bullet$ Cheyne-Stokes $\rightarrow$ Bilateral Cerebral Cortex Diencephalon
$\bullet$ Central Neurogenic Hyperventilation $\rightarrow$ Midbrain
$\bullet$ Apneustic Breathing $\rightarrow$ Pons
$\bullet$ Ataxic Biot Breathing $\rightarrow$ Medulla (pre-terminal)

Answer 1

The Correct Option is D

Concept:
Abnormal respiratory patterns provide essential localizing neuroanatomical value in comatose or brain-injured pediatric patients.
The pattern illustrating a crescendo-decrescendo hyperpneic phase alternating with periods of apnea is known as Cheyne-Stokes respiration.
Explanation:
• Cheyne-Stokes Respiration: Characterized by a cyclic pattern of smoothly waxing and waning tidal volumes (crescendo-decrescendo hyperpnea) followed by a period of central apnea.

• This breathing pattern reflects an increased ventilatory response to carbon dioxide (hypersensitivity to $\text{PaCO}_2$) combined with delayed circulatory feedback.

• It classically localizes to bilateral deep cerebral hemisphere (cortex/subcortex) or diencephalic lesions, or severe diffuse metabolic encephalopathy.

• Central Neurogenic Hyperventilation: Sustained, rapid, deep breathing seen in lesions of the midbrain (upper tegmentum).

• Apneustic Breathing: Prolonged inspiratory pauses followed by expiratory pauses, localizing to lesions of the middle/lower pons.

• Ataxic (Biot) Breathing: Completely irregular, chaotic breaths with unpredictable apneas, localizing to the respiratory centers in the dorsomedial medulla and signifying impending respiratory arrest.
Final Answer:
Cheyne-Stokes breathing with alternating hyperpnea and apnea is seen in lesions of the bilateral cerebral cortex and diencephalon.