Bilateral paramedian thalamic syndrome: abnormal circadian wake-sleep and autonomic functions

J Neurol Neurosurg Psychiatry. 2002 Dec;73(6):772-4. doi: 10.1136/jnnp.73.6.772.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Autonomic Nervous System Diseases / diagnosis*
  • Autonomic Nervous System Diseases / physiopathology
  • Body Temperature Regulation / physiology
  • Calcinosis / diagnosis*
  • Calcinosis / physiopathology
  • Circadian Rhythm / physiology
  • Dominance, Cerebral / physiology*
  • Energy Metabolism / physiology
  • Humans
  • Imaging, Three-Dimensional*
  • Neuropsychological Tests
  • Polysomnography
  • Sleep Disorders, Circadian Rhythm / diagnosis*
  • Sleep Disorders, Circadian Rhythm / physiopathology
  • Sleep Stages / physiology
  • Syndrome
  • Thalamic Diseases / diagnosis*
  • Thalamic Diseases / physiopathology
  • Thalamus / physiopathology
  • Tomography, Emission-Computed*