A man aged 48 years who had a history of obsessive compulsive disorder and depression was found unconscious on his basement floor with a nail gun. He arrived at the emergency room in a deep coma with a 15 cm (6 inches) nail embedded in the occipital lobe (figure A). The nail had entered through the frontal bone and traversed the midline through the diencephalic region, which led to severe intraparenchymal and intraventricular bleeding (figure B). The patient underwent surgery to remove the nail. Although the man did not have any sleep disorders before the traumatic brain injury, he developed substantial and persistent hypersomnolence with daily sleep duration of 20 h. When assessed at the Sleep Disorders Centre, the patient did not have neurological deficits and the obsessive compulsive disorder had completely resolved without medications. A polysomno-gram showed that sleep was highly fragmented and that there was an early onset rapid eye movement (REM) sleep (figure C). A multiple sleep latency test showed that sleep latency was shortened and REM sleep periods occurred in all 5 nap opportunities, consistent with the diagnosis of narcolepsy without cataplexy induced by traumatic brain injury. The patient"s hypersomnolence improved with the use of stimulant drugs (methylphenidate and modafinil). Sleep disorders, such as narcolepsy, are common in patients complaining of chronic hypersomnolence following a traumatic brain injury; appropriate therapy can lead to symptomatic relief.
展开▼
