Absence of REM sleep, altered NREM sleep and supranuclear horizontal gaze palsy caused by a lesion of the pontine tegmentum.

A 27-year-old woman with a mass lesion confined to the pontine tegmentum had absence of rapid eye movement (REM) sleep and abnormal nonrapid eye movement (NREM) sleep with no sleep spindles when the sole neurologic manifestation was a bilateral supranuclear horizontal gaze palsy. This study suggests that the tegmentum nuclei associated with REM sleep generation in humans and the pathways that control horizontal eye movements are closely related. Furthermore, these findings indicate that bilateral damage of the pontine tegmentum is necessary for REM sleep abolition. Interruption of connections between the tegmentum of the pons and the reticular nuclei of the thalamus could be the cause of the absence of sleep spindles.