Apneustic respirations are characterized by prolonged, gasping inspiration with a pause at full inspiration, indicating severe brain stem damage, particularly involving the pons.

Pathophysiology

Neurons in the pons and medulla regulate respiratory rhythm. Damage to pontine pathways disrupts this regulation, causing the apneustic breathing pattern.

Physical examination findings

• Consciousness: Profound stupor or coma.

• Pupils: Pinpoint, midline pupils.

• Eye movements: Ocular bobbing (spontaneous downward jerk followed by slow drift upward to midline).

• Motor: Quadriplegia or hemiplegia, often with eyes deviated toward the weak side.

• Reflexes:

  • Positive Babinski’s reflex (extensor plantar response).

  • Negative oculocephalic reflex (no doll’s eyes movement).

  • Negative oculovestibular reflex.

• Posture: Possible decorticate posturing.

• Respiratory pattern: Prolonged inspiratory phase with apnea at full inspiration.

History taking - important points

• Onset: Sudden or progressive neurological symptoms suggesting brainstem involvement.

• Precipitating events: Trauma, infection, stroke symptoms, or tumors.

• Associated symptoms: Headache, vomiting, seizures, altered mental status, focal neurological deficits.

• Medical history: Previous strokes, hypertension, infections, cancer, recent trauma.

• Family/caregiver input: Obtain history if patient is unconscious.

Emergency Interventions:

• Secure airway and maintain ventilation (insert artificial airway, administer oxygen).

• Initiate mechanical ventilation if needed.

• Assess neurologic status regularly (Glasgow Coma Scale or alternative in children).

• Obtain patient history from family or witnesses.

Medical causes

• Pontine infarction or hemorrhage

• Brainstem tumor

• Trauma to the pons

• Severe infection affecting brainstem

• Herniation syndrome

Special considerations

• Continuous monitoring of neurologic and respiratory status.

• Monitor arterial blood gases or oxygen saturation.

• Prepare for neurodiagnostic tests (CT, MRI, EEG).

Patient counseling

Explain diagnosis, treatment plan, and prognosis to patient’s family.

Pediatric pointers

Avoid Glasgow Coma Scale in young children due to verbal limitations; use pediatric coma scales instead.

If you want, I can also provide a formatted clinical checklist or patient handout based on this. Would that help?

References

1. Chou CH, Lin GM, Ku CH, Chang FY. Comparison of the APACHE II, GCS and MRC scores in predicting outcomes in patients with tuberculous meningitis. Int J Tuberc Lung Dis. 2010;14(1):86–92.

2. Looser RR, Metzenthin P, Helfrich TS, Kudielka BM, Loerbroks A, Thayer JF, Fischer JE. Cortisol is significantly correlated with cardiovascular responses during high levels of stress in critical care personnel. Psychosom Med. 2010;72(3):281–9.