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Case 14 - Violent sleep behavior resulting in subdural hemorrhage

from Part IV - Parasomnias

Published online by Cambridge University Press:  10 November 2010

Antonio Culebras
Affiliation:
Upstate Medical University, New York
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Summary

This chapter presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on a 73-year-old patient who complained of two recent violent dreams that resulted in significant injury. His past medical history included an anterior wall myocardial infarction, sinusitis and a remote history of tuberculosis. The patient was treated with clonazepam 1.0 mg every evening before sleep, with complete resolution of all violent dream-related behaviors over the following year. The MRI scan revealed a right subdural hematoma without mass effect, and a few small 2-3mm foci of deep white matter changes. The polysomnography (PSG) study revealed significant periodic limb movements. A follow-up assessment by a movement disorders specialist led to the diagnosis of Parkinson's disease. The patient's history and PSG analysis are classical for, and diagnostic of, REM-sleep behavior disorder (RBD), which is defined in ICSD-2 as a parasomnia associated with REM sleep.
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Chapter
Information
Case Studies in Sleep Neurology
Common and Uncommon Presentations
, pp. 92 - 100
Publisher: Cambridge University Press
Print publication year: 2010

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