Inserm UMR and Pierre and Marie Curie University, Hopital Pitié-Salpetrière, APHP, Paris, France.
Sleep Med. 2009 Oct;10(9):1059-62. doi: 10.1016/j.sleep.2008.12.006. Epub 2009 Apr 2.
A 40-year-old woman with no prior parasomnia developed an acute inflammatory rhombencephalitis with multiple cranial nerve palsies and cerebellar ataxia, followed by myelitis 6 months later, and by an intracranial thrombophlebitis 1 month after. Between and after these episodes, she had a persistent, mild right internuclear ophtalmoplegia, a mild cerebellar ataxia, and a severe REM sleep behavior disorder (RBD) lasting for 2 years. She talked, sang and moved nightly while asleep, and injured her son (cosleeping with her) while asleep. In addition, she walked asleep nightly. During video-polysomnography, there were two arousals during slow wave sleep without abnormal behavior, while 44% of REM sleep was without chin muscle atonia with bilateral arm and leg movements. There were small hypointensities in the right pontine tegmentum and in the right dorsal medulla on T1-weighted magnetic resonance imaging, suggesting post-inflammatory lesions that persisted between acute episodes. The RBD and sleepwalking did not improve with clonazepam, but improved with melatonin 9 mg/d. The unilateral small lesion of the pontine tegmentum could be responsible for the parasomnia overlap disorder as in other rare lesional cases.
一位 40 岁的女性，以前没有出现过睡眠相关行为障碍，出现了急性炎症性脑桥脑炎，伴有多个颅神经麻痹和小脑共济失调，6 个月后发展为脊髓炎，1 个月后出现颅内血栓性静脉炎。在这些发作期间和之后，她一直存在轻微的右侧核间眼肌麻痹、轻度小脑共济失调和严重的 REM 睡眠行为障碍（RBD），持续了 2 年。她在夜间睡觉时说话、唱歌和移动，并在睡觉时伤害了她的儿子（与她同睡）。此外，她还在夜间梦游。在视频多导睡眠图中，在慢波睡眠期间有两次唤醒，但没有异常行为，44%的 REM 睡眠没有颏肌松弛，伴有双侧手臂和腿部运动。T1 加权磁共振成像显示右侧脑桥被盖和右侧背髓有小的低信号，提示在急性发作之间存在炎症后病变，这些病变持续存在。氯硝西泮不能改善 RBD 和梦游，但 9 毫克/天的褪黑素可以改善。单侧脑桥被盖的小病变可能与其他罕见的病变病例一样，导致睡眠相关行为障碍重叠。
