A rare cause of acute onset central hypersomnia

Tuberculosis of the nervous system constitutes about 10% of total cases and is more common in developing countries like India. Varied clinical presentations, ranging from meningoencephalitis, tuberculoma, multiple cranial palsies to myelo-radiculitis, are noted. Here we highlight central sleep apnoea as an acute presentation, which is unusual in a neurological setting. Here, we present a 49-year old male, presented with acute onset of excessive daytime sleepiness for two weeks. Clinically he had no focal deficits. MRI brain plain and contrast showed multiple conglomerate ring-enhancing lesions with vasculitic infarcts consistent with tuberculosis. CSF analysis was normal apart from slightly elevated protein. He was initiated on steroids and anti-tuberculous therapy. Hypersomnia as an acute and solitary neurological presentation secondary to subacute infections is a rarity. Apart from vascular insults, infections like tuberculosis needed to be considered as one of the differentials. Early evaluation helps in prevention of associated complications and improve the quality of life.