A brainstem inflammatory lesion causing REM sleep behavior disorder and sleepwalking (parasomnia overlap disorder)

作者：Limousin Nadege; Dehais Caroline; Gout Olivier; Heran Francoise; Oudiette Delphine; Arnulf Isabelle^*

来源：Sleep Medicine, 2009, 10(9): 1059-1062.

DOI：10.1016/j.sleep.2008.12.006

• REM sleep behavior disorder
• Brainstem lesion
• Demyelinating diseases of the nervous system
• Melatonin
• Parasomnia overlap disorder
• Sleepwalking

A 40-year-old woman with no prior parasomnia developed an acute inflammatory rhombencephalitis with Multiple cranial nerve palsies and cerebellar ataxia, followed by myelitis 6 months later, and by an intracranial thrombophlebitis 1 month after. Between and after these episodes, she had a persistent, mild right internuclear ophtalmoplegia, a mild cerebellar ataxia, and a severe REM sleep behavior disorder (RBD) lasting for 2 years. She talked, sang and moved nightly while asleep, and injured her son (cosleeping with her) while asleep. In addition, she walked asleep nightly. During video-polysomnography, there were two arousals during slow wave sleep without abnormal behavior, while 44% of REM sleep was without chin muscle atonia with bilateral arm and leg movements. There were small hypointensities in the right pontine tegmentum and in the right dorsal medulla on T1-weighted magnetic resonance imaging, suggesting post-inflammatory lesions that persisted between acute episodes. The RBD and sleepwalking did not improve with clonazepam, but improved with melatonin 9 mg/d. The unilateral small lesion of the pontine tegmentum could be responsible for the parasomnia overlap disorder as in other rare lesional cases.

• 出版日期2009-10