Bilateral paramedian thalamic syndrome: abnormal circadian wake-sleep and autonomic functions.
OBJECTIVE
To describe wake-sleep and body core temperature (t degrees ) rhythm abnormalities in two patients with bilateral paramedian thalamic calcifications.


METHODS
Patients underwent (18F)FDG PET scans and 24 hour polygraphic recordings of wake-sleep and t degrees.


RESULTS
PET showed bilateral thalamic hypometabolism in both patients with additional basal ganglia or mesiolateral frontal and cingular hypometabolism. Wake-sleep studies showed abnormal sleep organisation and in the case with frontal and limbic PET hypometabolism, pre-sleep behaviour associated with "subwakefulness" EEG activities, lack of EEG spindles and K complexes, and features of status dissociatus. The t degrees rhythms showed increased mesor in both (37.4 degrees C and 37.75 degrees C) and inverted rhythm in one patient.


CONCLUSIONS
Paramedian thalamic structures and interconnected, especially frontal and cingular, areas play a part in the organisation of the wake-sleep cycle and attendant autonomic functions.
Montagna
P
P
Institute of Clinical Neurology, University of Bologna Medical School, Bologna, Italy. pmontagn@neuro.unibo.it
Provini
F
F
Plazzi
G
G
Vetrugno
R
R
Gallassi
R
R
Pierangeli
G
G
Ragno
M
M
Cortelli
P
P
Perani
D
D
D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000503:physiopathology; D001833:Body Temperature Regulation / Q000502:physiology; D002114:Calcinosis / Q000175:diagnosis* / Q000503:physiopathology; D002940:Circadian Rhythm / Q000502:physiology; D004292:Dominance, Cerebral / Q000502:physiology*; D004734:Energy Metabolism / Q000502:physiology; D006801:Humans; D021621:Imaging, Three-Dimensional; D009483:Neuropsychological Tests; D017286:Polysomnography; D020178:Sleep Disorders, Circadian Rhythm / Q000175:diagnosis* / Q000503:physiopathology; D012894:Sleep Stages / Q000502:physiology; D013577:Syndrome; D013786:Thalamic Diseases / Q000175:diagnosis* / Q000503:physiopathology; D013788:Thalamus / Q000503:physiopathology; D014055:Tomography, Emission-Computed