Obesity hypoventilation syndrome (OHS) is defined as the combination of daytime hypercapnia (awake PaCO2 ≥45 mm Hg) and obesity (body mass index ≥30 kg/m2). Untreated OHS is associated with comorbidities, including cardiovascular diseases, heart failure, pulmonary hypertension, and metabolic syndrome. Continuous positive airway pressure (PAP) therapy with non-invasive ventilation is the gold standard for treating OHS. PAP therapy is highly effective; however, some adverse effects can affect long-term compliance. Air leakage through the mouth or around a mask is a common adverse effect of PAP therapy. Air leakage through the nasolacrimal duct or due to unsealed circuits has also been reported as a complication of PAP therapy; however, it is relatively rare. Considering the negative association between the level of air leakage and adherence to PAP therapy, clarifying the cause of air leakage during PAP therapy and minimizing it are key to successful outcomes. We report a case of air leakage through the nasolacrimal duct that was improved by inserting a gel foam patch inside the lacrimal sac of a patient with OHS with a history of reconstructive surgery for nasolacrimal duct obstruction.

Obstructive sleep apnea (OSA) and atrial fibrillation (AF) are associated with increased morbidity and mortality. OSA and AF share multiple risk factors, including hypertension, cardiovascular disorders, congestive heart failure, and metabolic syndrome. Although the two conditions are likely to have a bidirectional association, recent studies have suggested that OSA contributes to the development of AF through direct mechanical effects on cardiac remodeling. We report a patient with severe OSA showing immediate conversion of AF to normal sinus rhythm with optimal continuous positive airway pressure (CPAP) therapy. This supports that OSA may lead to AF, which can be effectively reversed with CPAP therapy.

Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic emergency associated with the use of dopamine receptor-antagonist properties or the rapid withdrawal of dopaminergic medications. NMS is characterized by refractory hyperpyrexia, altered mental state, dysautonomia, and rigor. If hyperpyrexia persists, it can result in multiorgan failure. Herein, we report a case of NMS occurring after metoclopramide administration in a patient with pontine hemorrhage, which was successfully treated with targeted temperature management using a surface cooling device.

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is known as a maternally inherited mitochondrial disease with a m.3243A>G mutation in the MT-TL1 gene. Here, we report a case of targeted temperature management in a MELAS patient who had a cardiac arrest and severe lactic acidosis after recurrent seizures.

Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic emergency associated with the use of dopamine receptor-antagonist properties or the rapid withdrawal of dopaminergic medications. NMS is characterized by refractory hyperpyrexia, altered mental state, dysautonomia, and rigor. If hyperpyrexia persists, it can result in multiorgan failure. Herein, we report a case of NMS occurring after metoclopramide administration in a patient with pontine hemorrhage, which was successfully treated with targeted temperature management using a surface cooling device.

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is known as a maternally inherited mitochondrial disease with a m.3243A>G mutation in the MT-TL1 gene. Here, we report a case of targeted temperature management in a MELAS patient who had a cardiac arrest and severe lactic acidosis after recurrent seizures.