We report the case of a 38-year-old male patient who suffered a bilateral thalamic stroke. Magnetic resonance scans demonstrated a signal hyperintensity at the bilateral anteromedial thalamic level, suggestive of a bilateral thalamic infarction. The clinical picture during the first week following onset was characterized by hypersomnia and aggressive behavior to external stimuli, and thereafter, by a reduction in sleep-like behavior and the development of aggressive and disphoric behavior, impulse discontrol, apathy. Long-term polysomnography monitoring was performed in the course of the first month following onset. Day-time EEC recording in the first week after stroke featured low amplitude, irregular, diffuse alpha and theta frequencies, previously defined as "subwakefulness" or "dearousal", despite a sleep behavior displayed by the patient, with sleep posture, closed eyes, and lack of activity. Nighttime recordings showed a disorganization of sleep macro-and microstructure, mainly consisting in a slow wave sleep reduction and the lack of well-defined spindles with persistent, though reduced, K complexes. The following evolution was characterized by a gradual disappearance of daytime subwakefulness behavior and the reappearance of a night-sleep pattern similar to normal sleep. These findings are in agreement with the role of the thalamus in sleep organization.
Sleep structure in bilateral thalamic stroke: A case report
BONANNI, ENRICA;MAESTRI, MICHELANGELO;SICILIANO, GABRIELE;SARTUCCI, FERDINANDO;ORLANDI, GIOVANNI
2000-01-01
Abstract
We report the case of a 38-year-old male patient who suffered a bilateral thalamic stroke. Magnetic resonance scans demonstrated a signal hyperintensity at the bilateral anteromedial thalamic level, suggestive of a bilateral thalamic infarction. The clinical picture during the first week following onset was characterized by hypersomnia and aggressive behavior to external stimuli, and thereafter, by a reduction in sleep-like behavior and the development of aggressive and disphoric behavior, impulse discontrol, apathy. Long-term polysomnography monitoring was performed in the course of the first month following onset. Day-time EEC recording in the first week after stroke featured low amplitude, irregular, diffuse alpha and theta frequencies, previously defined as "subwakefulness" or "dearousal", despite a sleep behavior displayed by the patient, with sleep posture, closed eyes, and lack of activity. Nighttime recordings showed a disorganization of sleep macro-and microstructure, mainly consisting in a slow wave sleep reduction and the lack of well-defined spindles with persistent, though reduced, K complexes. The following evolution was characterized by a gradual disappearance of daytime subwakefulness behavior and the reappearance of a night-sleep pattern similar to normal sleep. These findings are in agreement with the role of the thalamus in sleep organization.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
