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This chapter presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on a 73-year-old patient who complained of two recent violent dreams that resulted in significant injury. His past medical history included an anterior wall myocardial infarction, sinusitis and a remote history of tuberculosis. The patient was treated with clonazepam 1.0 mg every evening before sleep, with complete resolution of all violent dream-related behaviors over the following year. The MRI scan revealed a right subdural hematoma without mass effect, and a few small 2-3mm foci of deep white matter changes. The polysomnography (PSG) study revealed significant periodic limb movements. A follow-up assessment by a movement disorders specialist led to the diagnosis of Parkinson's disease. The patient's history and PSG analysis are classical for, and diagnostic of, REM-sleep behavior disorder (RBD), which is defined in ICSD-2 as a parasomnia associated with REM sleep.
This chapter discusses the case of a 55-year-old woman who reported that for the previous 6 years she had been having episodes at night where she had dreams that often had a fearful content. It presents the clinical history, examination, diagnosis, and the results of the procedures performed on the patient. On examination she was anxious and cried during the interview. The differential diagnosis of paroxysmal nocturnal events includes parasomnia, seizures during sleep or a psychogenic disturbance. Parasomnia classification is usually based on the sleep phase during which the parasomnia occurs. Seizures seen in nocturnal frontal lobe epilepsy (NFLE) are sleep-related seizures that may be difficult to distinguish from other paroxysmal events at night. This is because the motor activity and vocalization may resemble other paroxysmal events with features such as cycling movements of the lower limbs and because patients may be partially responsive during the seizures.
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