Status dissociatus after surgery for tegmental ponto‐mesencephalic cavernoma: A state‐dependent disorder of motor control during sleep

Abstract

After surgery for a tegmental ponto-mesencephalic cavernoma, a patient developed sleep-related excessive fragmentary myoclonus, diffuse myoclonic jerks, simple quasipurposeful movements of the limbs, and rapid eye movement (REM) sleep behaviour disorder as motor features of status dissociatus, a condition in which elements of one state of being (wake, NREM and REM sleep) pathologically intrude into another.

From state dissociation to status dissociatus

“…53 Therefore, the thalamic involvement may be considered to be the anatomical biomarker of Agrypnia Excitata. 48,55 Accordingly, in the casereports describing the variant forms of CJD, without the prominent thalamic involvement, the fullblown spectrum of Agrypnia Excitata cannot be recognized, [60][61][62][63][64][65] and functional or anatomical abnormities of different part of the brain have been reported in the "intermittent/intermediate" subtype of SD. In fact, in the autoimmune encephalitis other than Morvan's syndrome, different structures apart from the thalamus, seem to be targeted by the neuropathological process, such as the dorsolateral midbrain, the amygdala, 23 the hypothalamus, and the mammillary bodies 24 in anti Ma encephalitis, the neocortex and the limbic area, in anti Lgi1 antibodies encephalitis, 67,68 the hypothalamus and the limbic area in Guillan-Barrè Syndrome 21 and Narcolepsy Type 1.…”

“…60,61 SD has been reported also in chronic bilateral vascular paramedian thalamic lesions, [62][63][64] and in a diencephalon and medial pons lesion, after surgery for a tegmental ponto-mesencephalic cavernoma. 65 These cases however lack autonomic imbalance. In the past, specific relationships between the immunologic pattern -namely the specific subtypes of VGKC, such as leucine-rich glioma inactivated 1 (Lgi1) and caspr2 -and the clinical phenotype have been suggested.…”

Rapid Eye Movement Sleep Behavior Disorder in a Patient with Brainstem Lymphoma

“…RBD is very common in several neurodegenerative diseases, including multiple system atrophy, dementia with Lewy bodies and Parkinson's disease (6)(7)(8). It is also rarely observed in some patients with focal lesions of the brainstem from various causes, including vascular diseases, multiple sclerosis and inflammatory lesions (9)(10)(11)(12)(13)(14)(15)(16)(17)(18). We herein report the case of an RBD patient with brainstem lymphoma.…”

Neurobiology of Arousal and Sleep: Updates and Insights Into Neurological Disorders

“…Neuroimaging studies show that damage within or near the pontine tegmental regions (which includes the SLD) is associated with RBD symptoms [97][98][99]. A recent imaging study in 36 human subjects with PD showed that the degree of neuromelanin signal (a surrogate marker for neuronal integrity) in the SLD strongly predicted REM sleep without atonia in PD patients with RBD, but not in PD patients without RBD [100].…”