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The relationship between sleep disorders – in particular sleep apnea, a highly prevalent condition – and common vascular disturbances such as stroke and hypertension is an area of active research. Summarizing the clinical evidence to date between sleep disorders and vascular pathology, this is the first time a comprehensive overview of this relationship has been covered in a single volume. Bringing together some of the world's most renowned authors in the field, Sleep, Stroke and Cardiovascular Disease contains recommended treatment plans – allowing for rapid and accurate diagnosis and management of patients – enabling learning from real experience. Of interest, not only, to specialists who intervene in diagnosis and management of sleep and stroke disorders such as neurologists, cardiologists and pulmonologists, the book will also be of value to primary-care practitioners, allowing them to arrive at better diagnoses and management of sleep and vascular disorders.
This chapter presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on a man who presented with frequent episodes of sudden and unexplained arousals from nocturnal sleep. The sleep medicine specialist ordered a full-night video-polysomnography (PSG) recording including standard bipolar EEG, right and left electro-oculograms (EOGs), surface EMG of the mylohyoideus muscle, ECG, oro-nasal, thoracic and abdominal respirograms, and circulating oxyhemoglobin saturation. The specialist decided to withdraw clonazepam and advised the patient not to drive due to drowsiness until the results of the investigations became available and appropriate therapy was prescribed. The sleep medicine specialist established a diagnosis of nocturnal frontal lobe epilepsy (NFLE) based on historical features and video-PSG findings. Nocturnal frontal lobe epilepsy is a peculiar partial epilepsy whose clinical features comprise a spectrum of paroxysmal motor manifestations of variable duration and complexity, occurring mainly during sleep.
This chapter discusses the case of an 8-year-old female who was admitted to a pediatric neurology clinic for evaluation of chronic sleep-related behaviors that were unresponsive to anticonvulsant treatment. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. The combination of polysomnography (PSG) and clinical history led to a diagnosis of both somnambulism (sleepwalking) and seizure disorder. The possibility that her sleepwalking episodes were representative of partial complex seizures or prolonged postictal states cannot be ruled out given the relative limitations of the evaluation. The EEG concomitants of an active seizure have classically included generalized depression or slowing, rhythmic slow-wave or spike/polyspike and wave activity that can occur immediately prior to or during an event, and postictal slowing or depression frequently following a spell. Video recording and response to treatment aid in making a diagnosis of probability.