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Central sleep apnea and ataxia caused by brainstem lesion due to chronic neuroleptospirosis

A 37-year-old man developed high fever with expectoration of blood and dyspnea. On examination, he had mild conjunctival injection. He was diagnosed with pneumonia and treated with empiric IV antibiotics. One week later, he developed dysarthria and ataxia ; brain CT showed normal results and he was discharged. In the next month, he developed apneas and mild snoring, with frequent awakenings, nonrestorative sleep, choking, and shortness of breath. He was diagnosed with central sleep apnea. At this point brain MRI was performed (figure) to reveal a heterogeneous process that was hyperintense on T2 and fluid-attenuated inversion recovery sequences with signs of perifocal edema located in medulla oblongata and caudal part of the pons, more pronounced on the left side and spreading to the middle cerebellar peduncle. After contrast application there was inhomogeneous postcontrast enhancement indicating disruption of the blood–brain barrier. Neurologic examination revealed dysarthria, dysphagia, absent palatal reflexes, left …

Central sleep apnea ; ataxia ; chronic ; neuroleptospirosis

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