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Rapid eye movement sleep behaviour disorder symptomatic of a brain stem cavernoma
Author(s) -
Felix Sandra,
Thobois Stephane,
PeterDerex Laure
Publication year - 2016
Publication title -
journal of sleep research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.297
H-Index - 117
eISSN - 1365-2869
pISSN - 0962-1105
DOI - 10.1111/jsr.12364
Subject(s) - excessive daytime sleepiness , medicine , polysomnography , non rapid eye movement sleep , restless legs syndrome , rapid eye movement sleep , anesthesia , pons , psychology , eye movement , sleep disorder , ophthalmology , apnea , insomnia , psychiatry
Summary A 75‐year‐old man complained of excessive daytime sleepiness ( EDS ), difficulty falling asleep and nocturnal agitation during sleep. Restless legs syndrome ( RLS ) was diagnosed and treated. Because of persistent EDS , snoring and nycturia, a nocturnal polysomnography ( PSG ) was performed. PSG showed high sleep fragmentation related to a moderate to severe obstructive sleep apnea syndrome. Continuous positive airway pressure treatment ( CPAP ) was proposed. Because of the persistence of abnormal nocturnal behaviours, characterized by screaming, punching and falling out of bed, a video‐ PSG with CPAP treatment was performed. The recording showed typical chin electromyography ( EMG ) activity increase associated with violent movements during rapid eye movement ( REM ) sleep, suggesting REM sleep behaviour disorders ( RBD ). Clinical neurological examination found no parkinsonian syndrome, no dysautonomic sign and no neurological focal sign. Dopamine transporter imaging [123I‐ FP ‐ CIT single photon emission computed tomography ( SPECT )] did not find any presynaptic dopaminergic pathways degeneration. Brain magnetic resonance imaging showed a vascular lesion suggestive of cavernoma located in the pons. The present case illustrates the complexity of sleep disturbance diagnosis with a possible entanglement of aetiologies responsible for nocturnal agitation, and confirms that an isolated pons cavernoma should be considered among the rare causes of RBD .