1/18. Neuropsychological and psychiatric complications in endoscopic third ventriculostomy: a clinical case report.The clinical case report of a patient who underwent an endoscopic third ventriculostomy for the treatment of a slit ventricle syndrome is presented. After surgery the patient developed a severe complication consisting of an organic personality disorder, characterised by impulsiveness, physical heteroaggressiveness, binge eating, hypersomnia and impairment of memory, and frontal-executive functions.A frontal lobe lesion may explain some of the symptoms presented, such as the uncontrolled impulses, the aggressive behaviour, and even the binge eating. However, a longitudinal neuropsychological evaluation showed a severe deficit in immediate memory and difficulties in planning and consolidation of newly learned information, which may be best related to damage in the frontal basal structures of the brain: the fornix and its connection to the hippocampus and the mamillary bodies. Postoperative MR images confirmed the clinical hypothesis. The emergence of such a severe organic personality disorder and cognitive disturbances as a psychiatric complication of an endoscopic third ventriculostomy has not, it seems, been previously reported elsewhere. Clinicians should take these possible complications into account when recommending this so-called minimally invasive neuroendoscopic procedure.- - - - - - - - - - ranking = 1keywords = hypersomnia (Clic here for more details about this article) |
2/18. Efficacy of lithium treatment in kleine-levin syndrome.The kleine-levin syndrome (KLS) is characterized by periodic, sudden-onset episodes of hypersomnia, compulsive hyperphagia, and behavioral-emotional symptoms, lasting from a few days to a few weeks, with complete remission in the intercritical periods. We report on efficacy of lithium treatment in a highly recurring form of the disorder in a 17-year-old male adolescent. The decreasing severity of the disorder paralleled the progressive increase of lithium dosage, up to 0.9 mEq l(-1). Implications regarding the pharmacological treatment of this neglected disorder are discussed.- - - - - - - - - - ranking = 1keywords = hypersomnia (Clic here for more details about this article) |
3/18. Periodic hypersomnia: case report with biochemical and EEG findings.We report on a 23-year-old patient with periodic hypersomnia. Electroencephalographic (EEG) background activity for this individual was slightly slowed in the EEG during an episode of hypersomnia, and intermittent slow activity was found in addition. Usual laboratory parameters were normal; however, leucine-enkephalin was markedly elevated in the plasma at that time, whereas free cysteine could not be demonstrated. Clinical findings were normal in the following years, and the EEG background activity returned to normal; leucine-enkephalin and cysteine also returned to normal values.- - - - - - - - - - ranking = 6keywords = hypersomnia (Clic here for more details about this article) |
4/18. Disturbed hypothalamic-pituitary axis in idiopathic recurring hypersomnia syndrome.Disturbed function of the hypothalamic-pituitary axis at adrenal and thyroid levels was found during an episode of hypersomnia in the idiopathic recurring hypersomnia syndrome. These endocrinological abnormalities, abolished ACTH and cortisol responses to insulin-induced hypoglycemia and absent TSH response to TRH, normalised thereafter in the symptom-free interval. These data support the hypothesis that kleine-levin syndrome is related to an intermittent hypothalamic dysfunction.- - - - - - - - - - ranking = 6keywords = hypersomnia (Clic here for more details about this article) |
5/18. Hypersomnia-sleep apnea due to micrognathia. Reversal by tracheoplasty.A 67-year-old woman with acquired micrognathia developed severe daytime hypersomnia, loud snoring, nocturnal enuresis, encopresis, and hypertension. A polysomnogram demonstrated 564 sleep apneas, primarily obstructive, recurrent hypoxia, a bradytachycardia, and absent stages III, IV, and REM sleep. endoscopy during sleep revealed recurrent active closure of the upper pharynx associated with loud snoring. A tracheoplasty was done because of severity of symptoms and failure of conservative therapy. Dramatic improvement in sleepiness and hypertension occurred within 48 hours. On postoperative night 15 a repeated polysomnogram showed only 23 apneas, no hypoxia or bradytachycardia, and long periods of stage II, IV, and REM sleep. patients with the hypersomnia-sleep apnea syndrome should be provided with a tracheal opening during sleep when severe daytime somnolence, cardiac arrhythmias, and hypertension are present.- - - - - - - - - - ranking = 2keywords = hypersomnia (Clic here for more details about this article) |
6/18. kleine-levin syndrome associated with fire setting.kleine-levin syndrome is characterized by periodic hypersomnia associated with megaphagia and striking behavioral and psychiatric symptoms; it occurs primarily in adolescent boys. We treated a 17-year-old boy who had typical recurring somnolent episodes. His bizarre behavior included fire setting and stealing, both of which may have represented compulsions. His EEG during a sleepy episode was diffusely abnormal with generalized slowing of background activity; as he awoke and improved clinically, his EEG returned to normal. Between episodes, his EEG was normal. The relationship between kleine-levin syndrome and other sleep disorders is discussed. The neurochemistry and neurocircuitry that may provide the requisite substrate for this complex and fascinating neuropsychiatric disorder are briefly reviewed.- - - - - - - - - - ranking = 1keywords = hypersomnia (Clic here for more details about this article) |
7/18. An unusual case of kleine-levin syndrome associated with sleep terrors.The authors describe a case of kleine-levin syndrome (KLS) which in the hypersomniac period presents, together with the classical symptoms, frequent arousals accompanied by sleep terrors. Polygraphic study shows the absence of any nyctohemeral cycle and very frequent parasomnias occurring during arousals from NREM sleep. On the basis of data from the literature, the authors suggest that a disturbance of maintenance of sleep might not be exceptional in KLS, even if none of the previous reports describes such frequent parasomnias.- - - - - - - - - - ranking = 1keywords = hypersomnia (Clic here for more details about this article) |
8/18. The Kleine-Levine syndrome--a variant?A case of kleine-levin syndrome in an older man is described, with a review of the literature. An important point is emphasized in our case in which the patient reacted unfavorably to Ritalin, becoming sexually aroused, although his hypersomnia improved. A possibly different mechanism in hypersomnia and hypersexuality is speculated.- - - - - - - - - - ranking = 2keywords = hypersomnia (Clic here for more details about this article) |
9/18. Syndrome of the paramedian thalamic arteries: clinical and neuroimaging correlation.Two patients had sudden alteration of consciousness followed by fluctuating hypersomnia and bilateral ophthalmoplegia. magnetic resonance imaging showed asymmetric, paramedian thalamic and midbrain lesions. The clinical and neuroimaging features are consistent with the syndrome of the paramedian thalamic arteries of the basilar communicating artery. These strokes were caused by an embolus to the rostral basilar artery originating from a fibrillating heart. magnetic resonance imaging clearly delineates the delicate pattern of arterial involvement in mesodiencephalic junction infarctions.- - - - - - - - - - ranking = 1keywords = hypersomnia (Clic here for more details about this article) |
10/18. kleine-levin syndrome ethiopathogenesis and treatment.The complex of the symptoms of psychic disorders and of the disorders of sleep, appetite, and food intake often forms the basis of the clinical picture of a mental disease. However, it is only rarely conceived in a complex manner as a set of physiologically interdependent functions. A remarkable proof of the interdependence of these functions is their complex disorder, the kleine-levin syndrome. The first descriptions of the symptoms of the kleine-levin syndrome can be found in the studies of several authors published as early as at the turn of the century. In 1942, the syndrome was designated by Critchley and Hoffmann after Willi Kleine and Max Levin, who defined it precisely in 1925 and 1929. The syndrome of periodic hypersomnia, megaphagia, and psychic disorders, originally described only in young males, was later found in females as well; the original very strict criteria were gradually broadened and complemented to some extent. At present, the most commonly accepted criterion for the diagnosis of the kleine-levin syndrome is the existence of the combined sleep disorder (hypersomnia or insomnia lasting from days to weeks), food intake disorders (megaphagia or anorexia), and various psychic abnormalities accompanying or following the attacks of the affection. We term the syndrome typical if the sleep disorder appears in the form of hypersomnia, food disorder in the form of megaphagia, and if psychic abnormalities are clearly expressed. On the other hand, we term the syndrome atypical if one of the main symptoms is opposite. The incomplete syndrome consists of only two main symptoms. The attacks of the affection set on mostly suddenly, lasting from several days to several weeks, ending suddenly again. The interparoxysmal periods last from several days to several months, sometimes even to several years. The etiopathogenesis of the affection is still unknown. A number of reports indicate a disorder of the diencephalon, perhaps only of the hypothalamus. The pathological-anatomical findings following the death of persons suffering from the disorders of sleep and food intake and from psychic abnormalities mostly reveal lesions in the region of the third brain ventricle. The development of the typical syndrome is benign, however, and morphological studies are not available. The typical kleine-levin syndrome can hardly escape the attention of clinicians owing to the richness and clarity of symptoms. The atypical or discretely expressed forms, however, often remain unrecognized even after a detailed medical examination and may lead to diagnostic uncertainty.(ABSTRACT TRUNCATED AT 400 WORDS)- - - - - - - - - - ranking = 3keywords = hypersomnia (Clic here for more details about this article) |
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