Thursday, October 23, 2014

Strange Behaviors

A 60 year old man with depression is brought in by his wife for strange behaviors while he's asleep. His wife says that over the last few years, she's noticed repeated episodes of vocalization and movement while he's asleep. The movements last less than a minute long but are purposeful; she says she's seen him throw a ball. He often makes benign hand gestures, and occasionally punches or kicks. He sometimes shouts or yells. Most times, he doesn't awaken, but occasionally he wakes up momentarily before falling back asleep. He usually remembers his dreams, and when he awakes, he might be briefly confused, but orients quickly. All these episodes happen during the EEG shown above. For social history, he did not graduate high school, he currently smokes a pack a day, and he has some pesticide exposure from farming. Review of systems is remarkable for anosmia and constipation.

Challenge: In a decade, he is diagnosed with Parkinson's disease, but what does he have now?

Image is in the public domain.


Craig Chen said...

Strange Behaviors

This is rapid eye movement (REM) sleep behavior disorder, a parasomnia characterized by dream-enactment behaviors due to loss of REM sleep atonia.

Sources: UpToDate; Wikipedia.

Anonymous said...

Hey, can you walk us through the interpretation of the EEG?

Craig Chen said...

Sure - sorry, this image was a little confusing. So this polysomnogram captures 30 seconds. The first two rows represent eye movement (highlighted by the red bar). Rows 3 through 6 show the EEG - classically in REM sleep, EEG shows desynchronization, faster and lower voltage activity (theta and beta) resembling wakefulness.