Visual hallucinations and pontine demyelination in a child: possible REM dissociation?
An 11 year-old-boy acutely developed complex visual and acoustic hallucinations. Hallucinations, consisting of visions of a threatening, evil character of the Harry Potter saga, persisted for 3 days. Neurological and psychiatric examinations were normal. Ictal EEG was negative. MRI documented 3 small areas of hyperintense signal in the brainstem, along the paramedian and lateral portions of pontine tegmentum, one of which showed post-contrast enhancement. These lesions were likely of inflammatory origin, and treatment with immunoglobulins was started. Polysomnography was normal, multiple sleep latency test showed a mean sleep latency of 8 minutes, with one sleep-onset REM period. The pontine tegmentum is responsible for REM sleep regulation, and contains definite "REM-on" and "REM-off" regions. The anatomical distribution of the lesions permits us to hypothesize that hallucinations in this boy were consequent to a transient impairment of REM sleep inhibitory mechanisms, with the appearance of dream-like hallucinations during wake.
Vita
Maria Gabriella
MG
Department of Neurosciences, Catholic University, Rome, Italy.
Batocchi
Anna Paola
AP
Dittoni
Serena
S
Losurdo
Anna
A
Cianfoni
Alessandro
A
Stefanini
Maria Chiara
MC
Vollono
Catello
C
Della Marca
Giacomo
G
Mariotti
Paolo
P
D001933:Brain Stem / Q000473:pathology*; D002648:Child; D003711:Demyelinating Diseases / Q000150:complications*; D003937:Diagnosis, Differential; D004213:Dissociative Disorders / Q000209:etiology / Q000503:physiopathology; D006212:Hallucinations / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D017286:Polysomnography; D011149:Pons / Q000502:physiology*; D011618:Psychotic Disorders / Q000209:etiology / Q000503:physiopathology; D012895:Sleep, REM / Q000502:physiology*