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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 20:1185-1186 (6 1999)
© 1999 American Society of Neuroradiology

LETTER

Reply

Andrei I. Holodny^d

^d Department of Radiology

David Marks^e

^e Department of Neurology UMDNJ—New Jersey Medical School Newark, NJ

Igor N. Pronin^f, Valery N. Kornienko^f and Alexei Petraikin^f

^f Department of Radiology

AV Golanov^g

^g Department of Neurosurgery Burdenko Institute of Neurosurgery Moscow, Russia

We would like to thank Drs. Hawley and Payne and Ms. Giannola for their letter in which they describe a "rare complication of hyperventilation" in a patient with glioblastoma multiforme. They describe a patient who developed transient focal neurologic symptoms during hyperventilation. The mechanism of these clinical findings, however, is unclear. Notwithstanding the described focal neurologic symptoms (right hemiparesis and aphasia), the accompanying EEG showed generalized slowing. It is well known that hyperventilation is associated with intermittent focal EEG slowing in patients with mass lesion, and Hawley et al provide an interesting hypothesis as to the cause. They note that hyperventilation may unmask the clinical effects of a focal CNS lesion. They hypothesize that because hyperventilation increased the tumor blood flow, it will produce increased mass effect on the adjacent brain and cause the focal findings. We welcome further investigation into this interesting effect.

An important issue is whether hyperventilation can be performed safely in the presence of brain tumor. Hyperventilation typically precipitates absence (petit mal) seizures with a generalized spike and slow wave discharge (1). It is distinctly uncommon for hyperventilation to precipitate partial (focal) seizures, which is the seizure type associated with intracranial mass lesions (2). Because the individuals in the group we studied had focal brain lesions, it is unlikely that hyperventilation would have triggered partial seizures in this group. The findings described by Hawley were easily reversible when hyperventilation was terminated, and should not cause long-term sequelae.

References

1. Esquivel E, Chaussain M, Plouin P, Ponsot G, Arthuis M. Physical exercise and voluntary hyperventilation in childhood absence epilepsy. Electroencephalogr Clin Europhysiol 1991;79:127-132

2. Spencer DD, Spenser SS, Mattson RH, Williamson PD. Intracerebral masses in patients with intractable partial epilepsy. Neurology 1984;34:432-436[Abstract/Free Full Text]

This Article Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Holodny, A. I. Articles by Golanov, A. Search for Related Content PubMed Articles by Holodny, A. I. Articles by Golanov, A.