Faludi Béla, Tóth Márton, Pusch Gabriella, Komoly Sámuel
Department of Neurology, University of Pécs, Pécs, Rét st. 2., H-7623, Hungary.
Sleep Breath. 2016 Mar;20(1):237-42. doi: 10.1007/s11325-015-1212-0. Epub 2015 Jun 13.
Bilateral paramedian thalamic stroke is characterized by hypersomnia, vertical gaze palsy, amnestic alteration, and apathic state. Combined lesion of the paramedian thalamus and mesencephalon bilaterally is extremely rare. Little is known about the breathing disturbances of the particular region due to the lesion. The following describes the specific case of a woman, age 62, with bilateral paramedian thalamic and mesencephalic stroke. Initially, the patient's complaints exhibited altered vigilance and vertical gaze palsy. Notably, following the acute phase, fluctuating hypersomnia was detected. The MRI (brain) revealed an ischemic lesion in the medial part of the mesencephalon and paramedian thalamus, bilaterally.
The aim of the present study is to elucidate the involvement and characteristics of sleep-related breathing abnormalities in the clinical manifestation of the combined paramedian thalamic and mesencephalic stroke.
Polysomnographic recordings were accomplished seven times with 1-week interval between the consecutive recordings, toward investigating the early changes of sleep and sleep-related breathing abnormalities.
Sleep structure examination featured a decrease in N3 and REM ratio and an increase in N1 and N2 ratio with minimal improvement during the recovery period. In contrast, significant changes were found in the breathing pattern: the initial central apnea dominance was followed by obstructive apneas with a gradual decrease of the total pathological respiratory events.
In addition to the structural abnormality of the sleep regulating network, sleep-disordered breathing is another possible cause of hypersomnia in patients afflicted with the present localization of the lesion.
双侧丘脑旁正中梗死的特征为嗜睡、垂直凝视麻痹、记忆改变和情感淡漠状态。双侧丘脑旁正中与中脑联合病变极为罕见。关于该特定区域病变所致的呼吸障碍知之甚少。以下描述了一名62岁女性双侧丘脑旁正中与中脑梗死的具体病例。起初，患者的主诉表现为警觉性改变和垂直凝视麻痹。值得注意的是，在急性期过后，检测到有波动性嗜睡。MRI（脑部）显示双侧中脑内侧和丘脑旁正中存在缺血性病变。
本研究的目的是阐明丘脑旁正中与中脑联合梗死临床表现中与睡眠相关呼吸异常的受累情况及特征。
进行了7次多导睡眠图记录，连续记录之间间隔1周，以研究睡眠的早期变化和与睡眠相关的呼吸异常。
睡眠结构检查显示N3期和快速眼动期比例降低，N1期和N2期比例升高，恢复期改善甚微。相比之下，呼吸模式有显著变化：最初以中枢性呼吸暂停为主，随后出现阻塞性呼吸暂停，总的病理性呼吸事件逐渐减少。
除了睡眠调节网络的结构异常外，睡眠呼吸障碍是患有该病变定位的患者嗜睡的另一个可能原因。
