Sudden onset of sleep caused by hypothalamic infarction: a case report.

Abstract

BACKGROUND:

Hypothalamic lesions, such as tumors and demyelinating diseases, reportedly cause abnormal sleepiness. However, stroke involving the hypothalamus has rarely been described. Here, we report a patient with infarction restricted to the hypothalamus who presented with sudden onset of sleep.

CASE PRESENTATION:

A 42-year-old woman with a history of migraine without aura presented with irresistible sleepiness and developed several episodes of sudden onset of sleep. Neurological examinations were unremarkable except for partial left Horner syndrome. Brain magnetic resonance imaging (MRI) revealed a high-intensity lesion restricted to the left hypothalamus on diffusion-weighted and fluid-attenuated inversion recovery MRI images. Cerebrospinal fluid (CSF) orexin-A levels obtained on hospital day 3 after her sleepiness had resolved were normal (337 pg/mL; normal > 200 pg/mL). Serum anti-nuclear and anti-aquaporin 4 (AQP4) antibodies and CSF myelin basic protein and oligoclonal band were negative. A small hypothalamic infarction was suspected, and the patient was treated with intravenous edaravone and argatroban, as well as oral clopidogrel. Three months later, there had been no clinical relapse, and the hypothalamic lesion had almost disappeared on follow-up MRI. No new lesion suggestive of demyelinating disease or tumor was observed.

CONCLUSION:

Hypothalamic stroke should be considered a cause of sudden onset of sleep.

• Authors: Takeo Matsubara, Keisuke Suzuki, Akiko Kawasaki, Masayuki Miyamoto, Madoka Okamura, Takashi Kanbayashi, Hidehiro Takekawa, Toshiki Nakamura, Yuji Watanabe, Masanori Matsubara, Koichi Hirata
• Journal: BMC neurology (BMC Neurol) Vol. 19 Issue 1 Pg. 182 (Aug 02 2019) ISSN: 1471-2377 [Electronic] England
• PMID: 31375081 (Publication Type: Case Reports, Journal Article)

Chemical References

• Aquaporin 4
• MBP protein, human
• Myelin Basic Protein
• Orexins

Topics

• Adult
• Aquaporin 4 (immunology)
• Brain Infarction (blood, complications, diagnostic imaging)
• Disorders of Excessive Somnolence (etiology)
• Female
• Humans
• Hypothalamic Diseases (blood, complications, diagnostic imaging)
• Hypothalamus
• Infarction
• Magnetic Resonance Imaging
• Myelin Basic Protein (blood)
• Neuroimaging
• Orexins (cerebrospinal fluid)
• Sleep