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REM sleep behavior disorder in a patient with pontine stroke

Zhang Xi1, Wang Luning

  • 1Department of Geriatric Neurology, Chinese PLA General Hospital, Fuxinglu 28, Beijing 100853, People's Republic of China. zhangxi@301hospital.com.cn

Sleep Medicine
|January 30, 2008
PubMed

Insights

Rapid eye movement sleep behavior disorder (RBD) can occur after pontine infarction. A single pontine lesion may be sufficient to cause RBD, as evidenced by this case study.

Area of Science:

  • Neurology
  • Sleep Medicine

Background:

  • Rapid eye movement sleep behavior disorder (RBD) is often associated with neurodegenerative diseases and brainstem lesions.
  • RBD occurring with isolated pontine infarction is rare.

Observation:

  • A 68-year-old man presented with violent sleep behaviors, including screaming, thrashing, and physical aggression, accompanied by nightmares.
  • Neurological examination revealed no significant findings, but brain MRI showed a lacunar infarct in the right paramedian pons.
  • Nocturnal polysomnography confirmed REM sleep without atonia and absence of EEG epileptiform activity.

Findings:

  • The patient was diagnosed with pontine infarction and RBD.
  • Treatment with clonazepam effectively resolved the nocturnal events.
  • This case suggests a unilateral pontine lesion can independently cause RBD.

Implications:

  • Pontine infarction should be considered in the differential diagnosis of RBD.
  • This finding highlights the role of specific pontine structures in REM sleep regulation.
  • Further research may elucidate the precise mechanisms linking pontine lesions to RBD.

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