Pathological breathing patterns after pneumococcal rhombencephalitis.

Apneustic breathing is an abnormal breathing pattern characterized by a prolonged inspiratory time with an endinspiratory pause versus a shorter expiratory time.1 The termination of respiration is considered to be controlled by the pontine respiratory group (PRG). The apneustic breathing pattern is very rare in humans. Patients with autonomic breathing failure have an impaired autonomic control of ventilation, although their voluntary control remains intact.2 This is usually because of congenital central hypoventilation syndrome. In rare cases, it can be observed following brainstem lesions. Because of the very rare descriptions of these pathological breathing patterns, still little is known about the impact of specific brainstem lesions on the control of ventilation in humans. We present a case of a patient with an incomplete locked-in syndrome and a respiratory drive dysfunction consisting of the combination of an apneustic-like breathing pattern while awake and an autonomic breathing failure while asleep due to the uncommon cause of pneumococcal rhombencephalitis.