Can’t Breathe or Won’t Breathe: How Would I Know if I Am Asleep?

Bruce Cohen and Jyoti Krishna

in A Case a Week: Sleep Disorders from the Cleveland Clinic

Published on behalf of Oxford University Press

Published in print September 2010 | ISBN: 9780195377729
Published online April 2013 | e-ISBN: 9780199322985 | DOI:
Can’t Breathe or Won’t Breathe: How Would I Know if I Am Asleep?

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Case 9 introduces a girl who in 1998, at age 4, was diagnosed with neurofibromatosis Type 1 (NF1) and a visual pathway glioma, which was treated with 6 months of intravenous chemotherapy (carboplatin and vincristine); in 2001 a diffuse intrinsic brainstem mass (low-grade infiltrating astrocytoma) was discovered, and treated with external beam radiotherapy. She had been in clinical and radiographic remission since that time, but in 2007, at age 12, she developed a sixth cranial nerve palsy and was found to have papilledema. Coupled with a history of long-standing ventriculomegaly, she underwent a third ventriculostomy and during surgery, her CSF pressure was found to be elevated, and the procedure resulted in effectively treating the increased intracranial pressure. On routine follow-up with her neuro-oncologist for tumor surveillance in 2008, she complained of feeling tired all the time, and she was showing mood changes and a decline in school performance. With this new history of excessive daytime fatigue, school failure and poor sleep patterns, she was referred for a consultation with a sleep specialist.

Chapter.  2496 words.  Illustrated.

Subjects: Neurology ; Sleep Medicine

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