Hypersomnia due to injury of the ventral ascending reticular activating system following cerebellar herniation: A case report. Issue 1 (January 2017)

• Record Type: Journal Article
• Authors: Jang, Sung Ho; Chang, Chul Hoon; Jung, Young Jin; Kwon, Hyeok Gyu
• Editors: Zhang., Qinhong
• Is Part Of: Medicine. Volume 96:Issue 1(2016)
• Page Start: e5678
• Publication Date: 2017-01
• Subjects: ascending reticular activating system -- cerebellar herniation -- diffusion tensor imaging -- hypersomnia -- stroke; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000005678
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Rationale: We report on a patient with hypersomnia who showed injury of the lower ascending reticular activating system (ARAS) following cerebellar herniation due to a cerebellar infarct, detected on diffusion tensor tractography (DTT). Patient concerns: A 53-year-old male patient was diagnosed as a left cerebellar infarct, and underwent decompressive suboccipital craniectomy due to brain edema at 2 days after the onset of a cerebellar infarct. Three weeks after onset when the patient started rehabilitation, he showed hypersomnia without impairment of consciousness; he fell asleep most of daytime without external stimulation and showed an abnormal score on the Epworth Sleepiness Scale: 15 (full score: 24, cut off for hypersomnia: 10). Diagnoses and Outcomes: On 3-week DTT, narrowing of the upper portion of the lower ventral ARAS between the pontine reticular formation and the hypothalamus was observed on both sides. In addition, partial tearing was observed in the middle portion of the right lower ventral ARAS. Lessons: In conclusion, we found injury of the lower ventral ARAS in a patient with hypersomnia following cerebellar herniation due to a cerebellar infarct.