{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T16:07:41Z","timestamp":1761581261973},"reference-count":74,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2014,12,2]],"date-time":"2014-12-02T00:00:00Z","timestamp":1417478400000},"content-version":"unspecified","delay-in-days":5144,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can. J. Neurol. Sci"],"published-print":{"date-parts":[[2000,11]]},"abstract":"<jats:sec id=\"S0317167100001104_abs1\"><jats:title>Background:<\/jats:title><jats:p>A 52-year-old woman with metastases in brain and bone had clinical and radiological response to therapy but died about 10 weeks after diagnosis. General autopsy failed to identify a primary neoplasm or an anatomic cause of death. Investigation of sudden respiratory cessation was a consideration when undertaking an anatomic study of the brain.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167100001104_abs2\"><jats:title>Methods:<\/jats:title><jats:p>Review of patient records and careful examination of the brain following autopsy were carried out.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167100001104_abs3\"><jats:title>Results:<\/jats:title><jats:p>The patient had terminal episodes of hypersomnia but episodes of sleep apnea were not observed. She received no respiratory support and no respiratory difficulties were recorded until she was pronounced dead at 7 a.m. Autopsy revealed metastatic adenocarcinoma in a pattern suggestive of a primary pulmonary neoplasm, including multiple cerebral metastases, although no significant pulmonary lesions of any type were found. A 0.2 cm metastatic adenocarcinoma was found in the nucleus of the tractus solitarius (NTS). No other tumor was present in the brain stem.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167100001104_abs4\"><jats:title>Conclusion:<\/jats:title><jats:p>Unilateral destruction of the NTS in the medulla would have severely disturbed the most critical point of convergence of autonomic and voluntary respiratory control and of cardiocirculatory reflexes in the central autonomic network. It is postulated that this caused respiratory arrest during a state transition from sleeping to waking. Few metastases to the medulla are reported, most are relatively large, and several have caused respiratory symptoms before death. The very small metastasis in our patient could be the direct anatomic cause of death, and as such it is an unusual complication of metastatic disease of which clinicians should be aware. It is speculated that dysfunction of direct NTS connections to the pons or of connections passing close to the metastatic deposit resulted in terminal hypersomnia.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0317167100001104","type":"journal-article","created":{"date-parts":[[2014,12,12]],"date-time":"2014-12-12T15:38:22Z","timestamp":1418398702000},"page":"328-332","source":"Crossref","is-referenced-by-count":9,"title":["Nucleus of the Tractus Solitarius Metastasis: Relationship to Respiratory Arrest?"],"prefix":"10.1017","volume":"27","author":[{"given":"Roy H.","family":"Rhodes","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. Robert","family":"Wightman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2014,12,2]]},"reference":[{"key":"S0317167100001104_ref008","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.33.6.717"},{"key":"S0317167100001104_ref005","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.45.3.589"},{"key":"S0317167100001104_ref033","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.153.3.6093189"},{"key":"S0317167100001104_ref058","article-title":"The brain and hypertension: reflections on 35 years of inquiry into the neurobiology of the circulation","volume":"70","author":"Reis","year":"1984","journal-title":"Circulation"},{"key":"S0317167100001104_ref065","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1968.00480020085008"},{"key":"S0317167100001104_ref064","first-page":"521","volume-title":"Developmental Neurobiology of Breathing","author":"Harper","year":"1991"},{"key":"S0317167100001104_ref022","first-page":"25","article-title":"Autopsy case of Wallenberg\u2019s syndrome caused by metastasis of lung neoplasm to the medulla oblongata","volume":"17","author":"Ogawa","year":"1977","journal-title":"Rinsho Shinkeigaku"},{"key":"S0317167100001104_ref014","first-page":"101","article-title":"Multiple sclerosis with medullary plaques and fatal sleep apnea","volume":"15","author":"Auer","year":"1996","journal-title":"Clin Neuropathol"},{"key":"S0317167100001104_ref025","first-page":"1980","volume-title":"Atlas of Tumor Pathology","author":"Carter"},{"key":"S0317167100001104_ref053","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(90)90142-7"},{"key":"S0317167100001104_ref073","doi-asserted-by":"publisher","DOI":"10.1177\/155005949602700109"},{"key":"S0317167100001104_ref042","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1984.2.3.169"},{"key":"S0317167100001104_ref043","first-page":"1205","article-title":"An overview of radiotherapy trials for the treatment of brain metastases","volume":"9","author":"Berk","year":"1995","journal-title":"Oncology"},{"key":"S0317167100001104_ref017","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1939.00190030135010"},{"key":"S0317167100001104_ref010","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410280511"},{"key":"S0317167100001104_ref021","first-page":"449","article-title":"Case Records of the Massachusetts General Hospital","volume":"285","year":"1971","journal-title":"N Engl J Med"},{"key":"S0317167100001104_ref055","doi-asserted-by":"publisher","DOI":"10.1016\/S0169-5002(99)00034-3"},{"key":"S0317167100001104_ref066","volume-title":"Clinical Neurology","volume":"4","author":"Glaser","year":"1983"},{"key":"S0317167100001104_ref047","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19860701)58:1<178::AID-CNCR2820580130>3.0.CO;2-T"},{"key":"S0317167100001104_ref051","doi-asserted-by":"publisher","DOI":"10.1007\/BF02236213"},{"key":"S0317167100001104_ref009","first-page":"1017","article-title":"A case of medullary infarction presented lateral medullary syndrome and respiratory arrest after ataxic respiration","volume":"29","author":"Hashimoto","year":"1989","journal-title":"Rinsho Shinkeigaku"},{"key":"S0317167100001104_ref006","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.159.1.9803051"},{"key":"S0317167100001104_ref016","doi-asserted-by":"publisher","DOI":"10.1007\/BF02013174"},{"key":"S0317167100001104_ref019","doi-asserted-by":"publisher","DOI":"10.1097\/00005072-194504000-00007"},{"key":"S0317167100001104_ref034","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0339(199906)20:6<325::AID-DC1>3.0.CO;2-N"},{"key":"S0317167100001104_ref007","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410010612"},{"key":"S0317167100001104_ref074","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410390409"},{"key":"S0317167100001104_ref067","first-page":"331","article-title":"Convergence of sleep-wakefulness subsystems onto single neurons in the region of cat\u2019s solitary tract nucleus","volume":"118","author":"Eguchi","year":"1980","journal-title":"Arch Ital Biol"},{"key":"S0317167100001104_ref054","doi-asserted-by":"publisher","DOI":"10.1007\/BF02058708"},{"key":"S0317167100001104_ref059","doi-asserted-by":"publisher","DOI":"10.1002\/cne.903470106"},{"key":"S0317167100001104_ref038","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19981215)83:12<2548::AID-CNCR21>3.0.CO;2-4"},{"key":"S0317167100001104_ref068","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.08-12-04790.1988"},{"key":"S0317167100001104_ref056","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1995.83.4.0605"},{"key":"S0317167100001104_ref002","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-198310000-00038"},{"key":"S0317167100001104_ref018","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1001\/archneur.1980.00500590093018","article-title":"Uncommon causes of the lateral medullary syndrome. Report of a case of metastatic carcinoma","volume":"37","author":"Ho","year":"1980","journal-title":"Arch Neurol"},{"key":"S0317167100001104_ref046","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19861215)58:12<2589::AID-CNCR2820581206>3.0.CO;2-O"},{"key":"S0317167100001104_ref003","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1986.64.2.0317"},{"key":"S0317167100001104_ref028","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19981115)83:10<2181::AID-CNCR17>3.0.CO;2-J"},{"key":"S0317167100001104_ref070","doi-asserted-by":"publisher","DOI":"10.1002\/cne.902690302"},{"key":"S0317167100001104_ref011","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(12)62272-1"},{"key":"S0317167100001104_ref030","first-page":"48","volume-title":"Russell and Rubinstein\u2019s Pathology of Tumors of the Nervous System","volume":"2","author":"McLendon","year":"1998"},{"key":"S0317167100001104_ref027","first-page":"338","volume-title":"Ackerman\u2019s Surgical Pathology","volume":"1","author":"Rosai","year":"1996"},{"key":"S0317167100001104_ref024","doi-asserted-by":"publisher","DOI":"10.1007\/BF00162766"},{"key":"S0317167100001104_ref013","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-5231(21)00965-5"},{"key":"S0317167100001104_ref036","doi-asserted-by":"publisher","DOI":"10.1006\/gyno.1996.0093"},{"key":"S0317167100001104_ref062","doi-asserted-by":"publisher","DOI":"10.1017\/S0317167100026585"},{"key":"S0317167100001104_ref023","doi-asserted-by":"publisher","DOI":"10.1016\/0303-8467(80)90037-2"},{"key":"S0317167100001104_ref041","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19820501)49:9<1916::AID-CNCR2820490926>3.0.CO;2-8"},{"key":"S0317167100001104_ref050","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-198809000-00011"},{"key":"S0317167100001104_ref052","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19831215)52:12<2349::AID-CNCR2820521231>3.0.CO;2-B"},{"key":"S0317167100001104_ref061","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.26.6.487"},{"key":"S0317167100001104_ref004","first-page":"990","article-title":"A case of unilateral brain stem tumor and impaired ventilatory response","volume":"32","author":"Osanai","year":"1994","journal-title":"Nihon Kyobu Shikkan Gakkai Zasshi"},{"key":"S0317167100001104_ref057","volume-title":"Breathing","author":"Plum","year":"1970"},{"key":"S0317167100001104_ref037","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19960815)78:4<711::AID-CNCR3>3.0.CO;2-H"},{"key":"S0317167100001104_ref026","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19961015)78:8<1781::AID-CNCR19>3.0.CO;2-U"},{"key":"S0317167100001104_ref032","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-8140(97)00124-2"},{"key":"S0317167100001104_ref048","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.1987.13"},{"key":"S0317167100001104_ref020","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.1966.tb01210.x"},{"key":"S0317167100001104_ref040","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/73.2.232"},{"key":"S0317167100001104_ref071","doi-asserted-by":"publisher","DOI":"10.1177\/155005948301400106"},{"key":"S0317167100001104_ref029","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.168.5.9129439"},{"key":"S0317167100001104_ref039","doi-asserted-by":"publisher","DOI":"10.3109\/07853899809005858"},{"key":"S0317167100001104_ref031","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(83)90319-X"},{"key":"S0317167100001104_ref001","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.11.7.597"},{"key":"S0317167100001104_ref035","first-page":"413","article-title":"Impact of prophylactic cranial irradiation in adenocarcinoma of the lung","volume":"92","author":"Tang","year":"1993","journal-title":"J Formos Med Assoc"},{"key":"S0317167100001104_ref015","first-page":"234","article-title":"Failure of automatic control of ventilation (Ondine\u2019s curse) associated with viral encephalitis of the brain stem: a clinicopathologic study of one case","volume":"7","author":"Giangaspero","year":"1988","journal-title":"Clin Neuropathol"},{"key":"S0317167100001104_ref044","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(98)00442-8"},{"key":"S0317167100001104_ref012","first-page":"854","article-title":"A case of multiple sclerosis with intractable hiccup and acute respiratory arrest","volume":"34","author":"Deguchi","year":"1994","journal-title":"Rinsho Shinkeigaku"},{"key":"S0317167100001104_ref072","doi-asserted-by":"publisher","DOI":"10.1097\/00004691-199001000-00005"},{"key":"S0317167100001104_ref060","doi-asserted-by":"publisher","DOI":"10.1002\/cne.902810107"},{"key":"S0317167100001104_ref045","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19800701)46:1<162::AID-CNCR2820460127>3.0.CO;2-B"},{"key":"S0317167100001104_ref069","doi-asserted-by":"publisher","DOI":"10.1016\/0301-0082(95)00023-O"},{"key":"S0317167100001104_ref049","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(87)90483-9"},{"key":"S0317167100001104_ref063","first-page":"122","article-title":"Ondine\u2019s curse \u2013 failure of respiratory center automaticity while awake. Abstract","volume":"10","author":"Severinghaus","year":"1962","journal-title":"Clin Res"}],"container-title":["Canadian Journal of Neurological Sciences \/ Journal Canadien des Sciences Neurologiques"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0317167100001104","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T11:24:48Z","timestamp":1628076288000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0317167100001104\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2000,11]]},"references-count":74,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2000,11]]}},"alternative-id":["S0317167100001104"],"URL":"https:\/\/doi.org\/10.1017\/s0317167100001104","relation":{},"ISSN":["0317-1671","2057-0155"],"issn-type":[{"value":"0317-1671","type":"print"},{"value":"2057-0155","type":"electronic"}],"subject":[],"published":{"date-parts":[[2000,11]]}}}