Teaching Video NeuroImages: Cluster Breathing in Brainstem-Sparing Bihemispheric Cerebral and Cerebellar Lesions

A 65-year-old comatose man with metastatic melanoma developed rapidly cycling breathing, clusters of approximately 10 abdominal excursions within 3 seconds, interspersed by seconds apnea (video 1 and figure), mimicking myoclonus. Introduced Plum Posner1 as a respiratory pattern associated lesions in the low pons or high medulla, cluster breathing can occur without pontomedullary when alkalosis accompanies bihemispheric lesions.2 It differs from constant tachypnea central neurogenic hyperventilation, also alkalosis, crescendo-decrescendo Cheyne-Stokes. Combined cerebellar cerebral may suffice to affect brainstem-mediated control absence brainstem lesions.