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Bilateral paramedian thalamic syndrome: abnormal circadian wake-sleep and autonomic functions
  1. P Montagna1,
  2. F Provini1,
  3. G Plazzi1,
  4. R Vetrugno1,
  5. R Gallassi1,
  6. G Pierangeli1,
  7. M Ragno2,
  8. P Cortelli1,
  9. D Perani3
  1. 1Institute of Clinical Neurology, University of Bologna Medical School, Bologna, Italy
  2. 2Department of Neurology, Hospital of Ascoli Piceno, Milan, Italy
  3. 3Institute of Neuroscience and Bioimaging, CNR, University Vita-Salute HRS, Scientific Institute, H San Raffaele, Milan, Italy
  1. 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

Abstract

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.

  • thalamus
  • circadian rhythm
  • sleep

https://doi.org/10.1136/jnnp.73.6.772

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