Reversible bilateral cerebellar ataxia resulting from hypercapnic encephalopathy in an undiagnosed patient with obstructive sleep apnoea.
Arihant Jain, Nayer Jamshed, Falgun Maheriya
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Case in brief
A man in his 40s with morbid obesity and type 2 diabetes presented with early-morning drowsiness and respiratory distress after nocturnal dyspnoea and diuretic use. He was intubated for acute-on-chronic hypercapnic respiratory acidosis. After extubation, he developed bilateral cerebellar ataxia despite normal neuroimaging. His symptoms resolved with ventilatory support and correction of PaCO₂, revealing severe obstructive sleep apnoea.
What made this case unusual
The case highlights hypercapnic encephalopathy manifesting as reversible bilateral cerebellar ataxia, which is an atypical presentation in the context of metabolic alkalosis and suspected chronic CO2 retention.
Diagnostic / clinical pearl
Clinicians should consider hypercapnic encephalopathy in patients with respiratory distress and neurological symptoms, particularly in the context of obstructive sleep apnoea.
Why it matters
This case underscores the importance of early arterial blood gas analysis and careful interpretation of ventilator waveforms in managing patients with respiratory failure.