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Central neurogenic hyperventilation has been reported in brainstem infiltration by tumors1 but seldom with acute posterior stroke. Vomiting is frequent with such strokes2 but usually not associated with hyperventilation. We describe a patient with acute occlusive posterior stroke in whom the combination of hyperventilation and vomiting delayed diagnosis.
Case report.
A 54-year-old man with diabetes mellitus and hypertension had nausea and vomiting for 1 day. Clinical examination was normal except for elevation of blood pressure (189/95 mm Hg) and respiratory rate (20/min). Laboratory tests showed blood glucose level of 213 mg/dL and white blood count of 15,800/mm3 with 83% neutrophils. Chest and abdominal radiographs were negative. He was given IV saline and sent home with a diagnosis of gastroenteritis.
The patient returned the next day with persistent vomiting, difficulty breathing, blurred vision, fever, and malaise. His respiration was 26/min. He was mentally alert but dysarthric. He had normal cranial nerves, normal motor examination, diminished pedal sensation and slowed hand coordination. Laboratory tests …
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