Chapter

When Dormant Issues Awaken, Waking Patients Sleep!

Roxanne Valentino and Farid Talih

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: http://dx.doi.org/10.1093/med/9780195377729.003.0027
When Dormant Issues Awaken, Waking Patients Sleep!

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Case 25 introduces a 16-year-old boy who presented for evaluation of daytime sleepiness, which was progressive over about 2 years, resulting in falling asleep in his classes and napping 1 or 2 hours per day. Medical history included craniopharyngioma diagnosed age 11, in the suprasellar region measuring 17x17x14 mm. The tumor was excised via standard pterional approach, and his perioperative course was uncomplicated. The postperative MRI scan showed complete resection of the mass with minimal contrast enhancement in the suprasellar cistern, thought to be postsurgical in nature. He was treated with hormonal replacement therapy for panhypopituitarism. His medications at the time of initial sleep evaluation included DDAVP, hydrocortisone, dexamethasone, testosterone, growth hormone, and levothyroxine. Subsequent MRI scans had been negative for tumor recurrence. He denied use of tobacco, alcohol, or illicit drugs.

Chapter.  1637 words.  Illustrated.

Subjects: Neurology ; Sleep Medicine

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