Automatic Respiratory Failure

Two patients had bilateral tegmental medullary infarcts with resultant acute failure of automatic respiratory function. Both patients were eventually able to maintain respiration unaided while awake, but remained apneic during sleep. This condition, referred to as Ondine's curse, has been described in association with bilateral high cervical cordotomy, bulbar poliomyelitis, and in single instances of brain stem tumor and infarction. Our cases add further support to the concept of two separate respiratory systems: a voluntary system, with cerebral centers and descending pathways associated with the pyramidal system; and an automatic system, with medullary tegmental centers and pathways in the anterolateral portions of the high cervical cord.