© 2002 Journal of Neurology Neurosurgery and Psychiatry
SHORT REPORT
Bilateral paramedian thalamic syndrome: abnormal circadian wake-sleep and autonomic functions
1 Institute of Clinical Neurology, University of Bologna Medical School, Bologna, Italy
2 Department of Neurology, Hospital of Ascoli Piceno, Milan, Italy
3 Institute of Neuroscience and Bioimaging, CNR, University Vita-Salute HRS, Scientific Institute, H San Raffaele, Milan, Italy
Correspondence to:
Correspondence to:
Professor P Montagna, Dipartimento di Scienze Neurologiche, dell'Università di Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy;
pmontagn{at}neuro.unibo.it
Objectives: To describe wake-sleep and body core temperature (t°) 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°.
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° rhythms showed increased mesor in both (37.4°C and 37.75°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.
Keywords: thalamus; circadian rhythm; sleep
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