Abstract
We report the case of a 32-year-old woman with a history of increased sleep need and difficulty waking up; the diagnosis of idiopathic hypersomnia was hypothesized. During ambulatory polysomnography (PSG), the patient presented an episode characterized by loss of consciousness and jerking of the four limbs. A video-PSG monitoring was performed and the patient showed unresponsiveness and drowsiness at 7 a.m. During the episode, EEG showed theta-delta diffuse activity, and blood glucose level was 32 mg dl(-1). The diagnosis of insulinoma was then assumed; CT scan showed a hypodense mass into the pancreatic tail, and a partial pancreasectomy was performed. The described symptoms disappeared, and 5 years later the findings of a complete clinical and neurophysiological examination were negative. The clinical picture of insulinoma presenting with paroxysmal disorders has been previously described; however, whereas hypersomnia is uncommon, in the current case it represents the main symptom. Clinicians should keep in mind that neuroglycopenia should be considered in the differential diagnosis of patients with hypersomnia, particularly if the clinical scenario does not conform to standard criteria.
References
Sep 1, 1992·Diabetologia·I BendtsonC Binder
Feb 1, 1992·Sleep·I BendtsonG Wildschiødtz
Jun 1, 1987·Electroencephalography and Clinical Neurophysiology·M SalinskyD Roscoe
Jun 6, 1998·The New England Journal of Medicine·T W JonesW V Tamborlane
Apr 6, 1999·The American Journal of Medicine·A M DizonB J Hoogwerf
Mar 29, 2001·Neurology·C W Bazil, A Pack
Jun 26, 2001·Psychiatry and Clinical Neurosciences·T HoriUNKNOWN Sleep Computing Committee of the Japanese Society of Sleep Research Society
Jan 18, 2003·Sleep Medicine Reviews·M Billiard, Y Dauvilliers
Dec 13, 2003·Journal of Endocrinological Investigation·A PiovesanG Borretta
Dec 16, 2003·Neurophysiologie clinique = Clinical neurophysiology·S StrianoV Percopo
Apr 28, 2004·Neurology·M-H DionD K Nguyen
Jul 20, 2004·Journal of Neurology, Neurosurgery, and Psychiatry·T D GravesG S Conway
Sep 6, 2005·Sleep Medicine·Michael J Thorpy
Sep 30, 2005·Epilepsia·Sean Stephen O'Sullivan, Janice Redmond
Nov 25, 2005·Diabetes·Philip E Cryer
Nov 24, 2006·European Journal of Pediatrics·Varsine Jaladyan, Vahagn Darbinyan
Apr 17, 2007·Physiology & Behavior·Nancy C TkacsAdrian R Morrison
Jun 11, 2008·Journal of Zhejiang University. Science. B·Shuang WangMei-ping Ding
Citations
Apr 10, 2014·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·A KawasakiK Hirata
Mar 16, 2017·Diabetology & Metabolic Syndrome·Weijun GuJingtao Dou
Oct 5, 2016·Molecular and Clinical Oncology·Jiali PuXinzhen Yin
Jun 25, 2015·Medicine·Keisuke SuzukiKoichi Hirata