![]() ![]() MSLT showed mean sleep latency of 1 min and three SOREM, indicating diagnosis of narcolepsy ( Fig. PSG showed sleep onset rapid eye movement (SOREM) with 33.3/hr of total arousal index, and 24.9/hr of apnea-hypopnea index ( Table 1). The Epworth Sleepiness Scale (ESS) was checked before starting the PSG study, where she had a 12 score point. Next, she underwent an overnight polysomnography (PSG), followed by a daytime multiple sleep latency test (MSLT). Although we did not record electromyography directly, the EEG certainly shows that muscle atnoia was present during the attack. The EEG and EKG showed neither ictal epileptiform discharge nor arrhythmia. She said that she did not lose her consciousness during the event. Whilst walking around the room, she suddenly fell down and did not react for 15 seconds, after which she fully recovered ( Fig. During the monitoring, one episode of event occurred. She underwent a 24-hour-video-electroencephalography (EEG) monitoring. However, the brain magnetic resonance image showed old insult of hemorrhage alongside the right external capsule, of which the patient was unaware ( Fig. The initial presumptive diagnosis was epileptic drop attack or paroxysmal kinesogenic dyskinesia rather than narcolepsy, since she did not complain subjective daytime sleepiness nor did she have any identifiable emotional trigger before the event, except physical trigger such as walking and standing up. She was referred to the neurology department to evaluate any underlying neurologic problems. The cardiac evaluation revealed normal electrocardiogram (EKG), 24-hour Holter recording, treadmill test and 2D echocardiogram. There were no warning signs such as dizziness, hallucination or autonomic symptoms before the attack started. However, the attacks usually occurred when she stood up, walked or spoke to people. She denied any emotional trigger factor for sudden fall, such as laughter, excitement, surprise and anger. ![]() Its frequency varied from five to seven episodes per day, increasing gradually. The duration of attacks was usually less than a minute. Usually, only her lower limbs were involved in the attacks, but sometimes there was a complete weakness that involved both arms and face too. However, she started to experience drop attacks that made her abruptly fall down and injure herself, without any alteration of consciousness. She also denied any sleep paralysis and hypnagogic hallucination, but acknowledged fragmented night-time sleep. She denied any subjective daytime sleepiness since then. These symptoms lasted three months, and then disappeared. Eight months back, there was a sudden development of excessive daytime sleepiness, along with long sleep durations (more than 12 hours a day). A 58-year-old Korean female presented with a 5-month history of recurrent drop attack. ![]()
0 Comments
Leave a Reply. |