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

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....

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Autores principales: Matsubara, Takeo, Suzuki, Keisuke, Kawasaki, Akiko, Miyamoto, Masayuki, Okamura, Madoka, Kanbayashi, Takashi, Takekawa, Hidehiro, Nakamura, Toshiki, Watanabe, Yuji, Matsubara, Masanori, Hirata, Koichi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676520/
https://www.ncbi.nlm.nih.gov/pubmed/31375081
http://dx.doi.org/10.1186/s12883-019-1414-3
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author Matsubara, Takeo
Suzuki, Keisuke
Kawasaki, Akiko
Miyamoto, Masayuki
Okamura, Madoka
Kanbayashi, Takashi
Takekawa, Hidehiro
Nakamura, Toshiki
Watanabe, Yuji
Matsubara, Masanori
Hirata, Koichi
author_facet Matsubara, Takeo
Suzuki, Keisuke
Kawasaki, Akiko
Miyamoto, Masayuki
Okamura, Madoka
Kanbayashi, Takashi
Takekawa, Hidehiro
Nakamura, Toshiki
Watanabe, Yuji
Matsubara, Masanori
Hirata, Koichi
author_sort Matsubara, Takeo
collection PubMed
description 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.
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spelling pubmed-66765202019-08-06 Sudden onset of sleep caused by hypothalamic infarction: a case report Matsubara, Takeo Suzuki, Keisuke Kawasaki, Akiko Miyamoto, Masayuki Okamura, Madoka Kanbayashi, Takashi Takekawa, Hidehiro Nakamura, Toshiki Watanabe, Yuji Matsubara, Masanori Hirata, Koichi BMC Neurol Case Report 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. BioMed Central 2019-08-02 /pmc/articles/PMC6676520/ /pubmed/31375081 http://dx.doi.org/10.1186/s12883-019-1414-3 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Matsubara, Takeo
Suzuki, Keisuke
Kawasaki, Akiko
Miyamoto, Masayuki
Okamura, Madoka
Kanbayashi, Takashi
Takekawa, Hidehiro
Nakamura, Toshiki
Watanabe, Yuji
Matsubara, Masanori
Hirata, Koichi
Sudden onset of sleep caused by hypothalamic infarction: a case report
title Sudden onset of sleep caused by hypothalamic infarction: a case report
title_full Sudden onset of sleep caused by hypothalamic infarction: a case report
title_fullStr Sudden onset of sleep caused by hypothalamic infarction: a case report
title_full_unstemmed Sudden onset of sleep caused by hypothalamic infarction: a case report
title_short Sudden onset of sleep caused by hypothalamic infarction: a case report
title_sort sudden onset of sleep caused by hypothalamic infarction: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676520/
https://www.ncbi.nlm.nih.gov/pubmed/31375081
http://dx.doi.org/10.1186/s12883-019-1414-3
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