11/18. Abnormal central monoamine metabolism in humans with "true hypersomnia" and "sub-wakefulness".A case of kleine-levin syndrome with true hypersomnia and a case of sub-wakefulness are described. In both patients lumbar cerebrospinal fluid homovanillic acid, 5-hydroxyindoleacetic acid, 3-methoxy-4-hydroxyphenylethylene glycol levels have been assayed during episodes of hypersomnia and normal sleep-waking cycles. Besides an increased 5-hydroxytryptamine turnover, mainly an increased dopamine turnover has been detected in both kinds of hypersomnia, and this finding was more remarkable in the case with sub-wakefulness. The probable role of dopamine in abnormalities in the sleep-waking cycle is discussed on the basis of results in experimental animal hypersomnias.- - - - - - - - - - ranking = 1keywords = hypersomnia (Clic here for more details about this article) |
12/18. slit ventricle syndrome presenting with paroxysmal hypersomnia in an adult: case report.The slit ventricle syndrome (SVS), defined as intermittent shunt malfunction without substantial ventricular enlargement, is usually observed in shunted children with small, slitlike ventricles. This syndrome has been attributed to recurrent obstruction of the ventricular catheter, which then causes an increase of intracranial pressure. Only rarely has the SVS been reported in adults. We describe a 29-year-old woman whose shunt malfunction presented with long-lasting paroxysmal hypersomnia and was diagnosed with computed tomographic evidence of small lateral ventricles. This episodic hypersomnia presented every 2 to 3 weeks and each episode lasted 1 to 2 weeks. After revision of the ventricular catheter, her symptoms stopped and she remained well.- - - - - - - - - - ranking = 0.75keywords = hypersomnia (Clic here for more details about this article) |
13/18. A case of multiple sclerosis with an onset mimicking the kleine-levin syndrome.A 20 years old patient is described, who presented two episodes of day-time hypersomnia, orthostatic hypotension and psychotic behavior. Compulsive masturbation and abnormalities of the eating habits were also present. Both episodes cleared up spontaneously in about one week. From the clinical point of view of kleine-levin syndrome, was suspected. However a CSF examination showed IgG oligoclonal bands and an increased IgG index. A NMR showed multiple area of increased signal intensity, suggestive of a demyelinating disease. On these elements a final diagnosis of MS was made, in spite of a normal neurological examination. This case was compared to other cases of MS in which the disease begins with acute remitting psychiatric symptoms. However cases of MS with complex episodes as observed in our patient were not found in the literature.- - - - - - - - - - ranking = 0.125keywords = hypersomnia (Clic here for more details about this article) |
14/18. The syndrome of bilateral paramedian thalamic infarction.Bilateral anterior paramedian thalamic infarction resulting from occlusion of a bilaterally distributed thalamosubthalamic paramedian artery was demonstrated on CT in two patients. Patient 1 presented with a transient coma followed by asterixis, hypersomnia, vertical gaze disturbances, profound Korsakoff amnesic syndrome, and a subcortical dementia. Patient 2, with a predominantly right-sided thalamic infarct, showed good recovery from amnesia and vertical gaze disturbances. However, patient 1 remained with severe amnesia and mild subcortical dementia at follow-up 1 year later. These and similar reported cases constitute a lacunar syndrome with characteristic clinical and CT features.- - - - - - - - - - ranking = 0.125keywords = hypersomnia (Clic here for more details about this article) |
15/18. Surgical syndromes of the hypothalamus.The clinical syndromes described with lesions of the hypothalamus are summarized in Table 9.5-9.7. The anterior hypothalamic syndrome consists of insomnia and loss of thirst regulatory mechanisms. In occasional larger lesions which interrupt the output from the supraoptic and paraventricular nuclei, diabetes insipidus has been noticed. In the tuberal region of the hypothalamus the most prominent findings are those that are caused by the disruption of the final common pathway to the pituitary. This results in endocrinopathy, most often the syndrome originally reported by Frohlich, with failure of sexual maturation and obesity. In the tuberal region, differences between lesions of the medial and lateral portions are quite marked. Medial lesions result in obesity while bilateral lesions result in anorexia and emaciation. The diencephalic syndrome of infancy with it's severe emaciation in young years and obesity in later years clearly indicates a different organizational pattern in the neonatal hypothalamus. Emotional disorders may be seen with lesions either in the medial or lateral hypothalamus at the tuberal level. Finally, in the posterior hypothalamic region, which includes the greatest effector apparatus, hypersomnia, apathy, and poikilothermia have been reported. Emotional disturbances and the Wernicke-korsakoff syndrome also seemed to be associated with lesions in this area. The hypothalamus remains the single most important integrator of vegetative and endocrinologic regulation of the body. Cushing said of the hypothalamus, "here in this hidden spot, almost to be covered with a thumb nail, lies the very main spring of primitive existence: vegetative, emotional and reproductive".- - - - - - - - - - ranking = 0.125keywords = hypersomnia (Clic here for more details about this article) |
16/18. Fibrositis syndrome and narcolepsy.Fibrositis is often associated with sleep disturbances and with an alpha nREM abnormality on sleep electroencephalogram. We describe a case occurring during the course of a typical longstanding narcolepsy-cataplexy. Modafinil, that is an effective treatment of hypersomnia, did not alleviate the symptoms of fibrositis in the short term.- - - - - - - - - - ranking = 0.125keywords = hypersomnia (Clic here for more details about this article) |
17/18. sleep patterns in kleine-levin syndrome.Diurnal and nocturnal sleep records were obtained from a male and a female with kleine-levin syndrome, during excessive daytime sleep attacks and while they were asymptomatic. A common pattern of abnormal sleep was seen in both patients even during the asymptomatic period. The female, aflicted with a severe form of periodic hypersomnia, showed nocturnal and diurnal sleep onset REM periods. The different pattern of sleep abnormality in the female could be an expression of the severity of her symptoms or might indicate a variant of sleep abnormality present only in females with kleine-levin syndrome.- - - - - - - - - - ranking = 0.125keywords = hypersomnia (Clic here for more details about this article) |
18/18. Two occult causes of insomnia and their therapeutic problems.Insomnia may be associated with a sleep-induced apnea syndrome in nonobese patients who snore. The "central" type of apnea appears to be predominant in this population, in opposition to Pickwickian and nonobese hypersomniacs. An abnormal "swallowing reflex syndrome," also induced by sleep, may be a differential diagnosis. Sleeping pills that are central nervous system depressants should be cautiously prescribed for patients with such syndromes.- - - - - - - - - - ranking = 0.125keywords = hypersomnia (Clic here for more details about this article) |
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