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Case Reports
.2022 Mar 14:16:830474.
doi: 10.3389/fnins.2022.830474. eCollection 2022.

Case Report: Dysfunction of the Paraventricular Hypothalamic Nucleus Area Induces Hypersomnia in Patients

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Case Reports

Case Report: Dysfunction of the Paraventricular Hypothalamic Nucleus Area Induces Hypersomnia in Patients

Zan Wang et al. Front Neurosci..

Abstract

Background: Hypersomnia is a common and highly impairing symptom marked by pathological excessive sleepiness, which induces suboptimal functioning and poor quality of life. Hypersomnia can be both a primary (e.g., hypersomnolence disorder) and secondary (e.g., tumors, and head trauma) symptom of disorders. However, its underlying mechanisms remain largely unknown.

Case presentation: We report that three clinical cases with lesions around the paraventricular nucleus of the hypothalamus (PVH) area showed excessive daytime sleepiness and a prolonged nocturnal sleep lasting more than 20 h per day. Sleep architecture and subjective daytime sleepiness were examined by polysomnography. These cases were presented with stroke, myelin oligodendrocyte glycoprotein (MOG) antibody associated disorders and neuromyelitis optical spectrum disorder (NMOSD), respectively. Magnetic resonance imaging (MRI) showed lesions around the PVH area in all these three patients. After treatment of their primary disorders, their excessive sleep decreased as the PVH area recovered.

Conclusion: Our findings suggest that the PVH may play an essential role in the occurrence of hypersomnia.

Keywords: case report; hypersomnia; lesion; magnetic resonance imaging; polysomnography; the paraventricular hypothalamic nucleus.

Copyright © 2022 Wang, Zhong, Jiang, Qu, Huang and Chen.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Timeline of case I(A), case II(B) and case III(C). HD, hospital day; CT, computed tomography; MRI, magnetic resonance imaging; TST, total sleep time; PSG, polysomnography; IVMP, IV methylprednisolone; MOG, myelin oligo-dendrocyte glycoprotein; CSF, cerebro-spinal fluid; PVH, paraventricular nucleus of the hypothalamus.
FIGURE 2
FIGURE 2
Three patients with lesions in the PVH areas showed hypersomnia.(A) DWI signals of the three patients, which suggest strong signals in the left hypothalamus (I). The injury was in the right hypothalamus and showed a slight hypersignal in the FLAIR image (II). The lesion was in the bilateral hypothalamus and showed a slight hyper signal in the FLAIR image (III). White arrows indicate the sites of injury.(B) A sleep-structure chart. The N2 stage was dominant, accounting for 74.9% of the total sleep time in case I, 74.1% in case II, and 89.0% in case III. Blue lines represent wakefulness, red lines represent REM sleep, and black lines represent NREM sleep (including stages N1, N2, and N3).(C) The sleep duration of N1, N2, N3, and REM in all three cases.
FIGURE 3
FIGURE 3
Comparison of the lesion areas and sleep structure of case III before and after treatment.(A) The FLAIR of case III, which indicates the lesions were in the bilateral hypothalamus. White arrows indicate the injury sites.(B) A sleep-structure chart of case III before and after treatment. Blue lines represent wakefulness, red lines represent REM sleep, and black lines represent NREM sleep (including stages N1, N2, and N3).(C) The TST, the duration of N1, N2, and N3 stages, and REM sleep of case III, before and after treatment, during a 24 h sleep–wake cycle.
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