原発性中枢神経系リンパ腫後の重度の日中の眠気を呈する62歳男性

A 62-year-old man with a history of primary central nervous system lymphoma first presented with diplopia, diagnosed 2 years ago. A brain MRI showed multiple solid enhancing mass lesions located at the midline bilateral dorsal medulla to both cervicomedullary junction and right flocculus with edema of the ventrolateral medulla. The brain biopsy confirmed relapsed diffuse large B cell lymphoma. Remission was achieved after a course of high-dose methotrexate, rituximab, and whole-brain radiotherapy. He was referred to the sleep clinic because of snoring, witnessed apnea, and severe daytime sleepiness. He had no dyspnea, cough, or history of aspiration pneumonia. Medications included levetiracetam and midodrine.