Sonolência diurna excessiva pós-traumatismo de crânio: associação com movimentos periódicos de pernas e distúrbio de comportamento do sono REM: relato de caso

Abstract

RESUMO -Um homem de 52 anos, procurou o Hospital. Universitário de Brasília com queixa de sono agitado. Sua esposa relatava, desde há cerca de 10 anos, intensa movimentação de membros e agressividade em meio a sonhos violentos. Desde então apresentava sonolência diurna excessiva. Havia relato de traumatismo de crânio há 34 anos e coma de 2 meses de duração. A vídeo-polissonografia revelou comportamento agressivo e agitado durante o sono REM, e movimentos periódicos de pernas. Havia importante sonolência diurna no teste de latências de sono. Foi instituído tratamento com levodopa-benzerazida 100/25 mg à noite. Após 10 semanas de evolução, houve melhora da movimentação noturna global, e desaparecimento dos episódios ligados a sonhos de conteúdo violento. Este caso nos permite analisar a associação entre trauma craniano e alterações nas vias dopaminérgicas (movimentos periódicos das pernas e distúrbio de comportamento do sono REM) e revisar a importância dos distúrbios na produção de hipocretina hipotalâmica na fisiopatologia desse quadro clínico.PALAVRAS-CHAVE: traumatismo de crânio, vias dopaminérgicas, hipocretina, distúrbio de comportamento do sono REM, movimentos periódicos de pernas.Excessive daytime sleepiness after traumatic brain injury: association with periodic limb movements Excessive daytime sleepiness after traumatic brain injury: association with periodic limb movements Excessive daytime sleepiness after traumatic brain injury: association with periodic limb movements Excessive daytime sleepiness after traumatic brain injury: association with periodic limb movements Excessive daytime sleepiness after traumatic brain injury: association with periodic limb movements and REM behavior disorder and REM behavior disorder and REM behavior disorder and REM behavior disorder and REM behavior disorder. Case report . Case report . Case report . Case report . Case report ABSTRACT -A 52 year-old male patient, had complaint of "restless sleep". His wife informed that for the past ten years the patient had presented intense and aggressive body movements, and sometimes, violent dreams. The patient also complained of excessive daytime sleepiness. His relevant previous medical history included a traumatic brain injury at the age of 28 which left him in coma for two months. A video-polysomnography showed periodic leg movements and, during REM sleep, aggressive and agitated behaviour. The multiple sleep latency test revealed extremely short latencies. Initially, he was treated with levodopa-benzerazide, 100/25 mg, 2 hours before bedtime. After 10 weeks his overnight behaviour pattern improved and leg movements diminished. This case supports the hypothesis of an association between cranial trauma and alterations in the dopaminergic pathways represented by periodic leg movements during sleep and a sleep behaviour disorder and proposes the possibility of hypothalamic hypocretin involvement in its pathophysiology.KEY WORDS: cranial trauma, dopaminergic pathways, hypocretin, REM behaviour disorder, periodic leg movements.Os ...

Sleep disorders frequency in post-polio syndrome patients caused by periodic limb movements

“…It is important take in account that the PSG findings themselves do not determine the illness, but should be considered their as part of clinical context 17 . PLMS may be associated with dopaminergic system deregulation or hypoactivity due to excessive diurnal sleepiness causing functional impairment and a lost of sleep quality 18 . In conclusion, the polysomnography records are an apt way of establishing PLMS in PPS.…”