[A case of Cheyne-Stokes respiration with cyclic mutism during apneic period]

A 77-year-old man showed Cheyne-Stokes respiration (CSR) without a consciousness disturbance. In each apneic period of CSR, he became mute. In the apneic and mute state, he could open his mouth or protrude his tongue, but he could not breath or speak. In this patient, it was evident that not only phonation but also speech was under the control of respiration. Neuroimaging technique revealed an infarction in the right anterior cingulate gyrus and supplementary motor area as well as the entire perfusion area of the right middle cerebral artery. Marked atrophy of bilateral cerebral hemispheres was also observed. In this case, destruction of the right cingulate gyrus was thought to manifest occult functional fluctuation of the left cingulate gyrus influenced by the respiratory control mechanisms. This case suggested that the limbic system integrates the speech mechanism and the respiratory mechanism.