Axial herniation with brain stem deformity as a cause of sleep apnea.

A patient with an intracerebral hematoma and associated edema in the high right hemisphere parasagittal convexity had several episodes of apnea at night and during the day when she was asleep. On computed tomography (CT) scan, the hematoma demonstrated no evidence of brainstem compression. Sagittal magnetic resonance image (MRI), revealed the hematoma and edema mass resulted in central herniation with axial deformity of the brainstem. This is believed to be the cause of the apneic episodes. Treatment with mannitol and steroids promptly relieved the symptom.