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Bilateral paramedian thalamic syndrome: abnormal circadian wake-sleep and autonomic functions
P Montagna1, F Provini, G Plazzi
1Institute of Clinical Neurology, University of Bologna Medical School, Bologna, Italy. pmontagn@neuro.unibo.it
Objectives:
To describe wake-sleep and body core temperature (t degrees ) rhythm abnormalities in two patients with bilateral paramedian thalamic calcifications.
Methods:
Patients underwent (18F)FDG PET scans and 24 hour polygraphic recordings of wake-sleep and t degrees.
Results:
PET showed bilateral thalamic hypometabolism in both patients with additional basal ganglia or mesiolateral frontal and cingular hypometabolism. Wake-sleep studies showed abnormal sleep organisation and in the case with frontal and limbic PET hypometabolism, pre-sleep behaviour associated with "subwakefulness" EEG activities, lack of EEG spindles and K complexes, and features of status dissociatus. The t degrees rhythms showed increased mesor in both (37.4 degrees C and 37.75 degrees C) and inverted rhythm in one patient.
Conclusions:
Paramedian thalamic structures and interconnected, especially frontal and cingular, areas play a part in the organisation of the wake-sleep cycle and attendant autonomic functions.