title: Hypocretin-1 levels in the cerebrospinal fluid of patients with Percheron artery infarction with or without midbrain involvement: A case series.
abstract: BACKGROUND
  Bilateral paramedian thalamic infarctions (BPTIs) due to artery of Percheron occlusion are known to cause hypersomnia. However, the role of hypocretin-1, a wake-promoting peptide that is located at the lateral hypothalamus, in hypersomnia in these patients remains unclear.
  
  
  METHODS
  To clarify the role of hypocretin-1 in hypersomnia in patients with BPTIs, hypocretin-1 levels in the cerebrospinal fluid (CSF) were measured in 6 patients with BPTIs: 2 with rostral midbrain involvement (BPT+RMI) and 4 without midbrain involvement (BPT-MI).
  
  
  RESULTS
  CSF hypocretin-1 levels were decreased in 2 patients with BPT+RMI and were within normal ranges in 4 patients with BPT-MI. Hypersomnia was noted in all the patients. In one BPT+RMI patient, hypersomnia was improved within 2 weeks and decreased CSF hypocretin-1 levels were reversed (acute phase (on day 9), 109.2 pg/mL; chronic phase (at 3 months), 323 pg/mL), whereas another BPT+RMI patient who displayed coma in the acute phase had decreased CSF orexin levels (107 pg/mL) at day 49 and exhibited severe disability.
  
  
  CONCLUSIONS
  Hypocretin deficiency was not involved in hypersomnia observed in BPT-MI patients; however, CSF hypocretin-1 levels were reduced in BPT+RMI patients. Reduced CSF hypocretin-1 levels in the chronic phase may possibly predict a poor clinical outcome in patients with Percheron artery infarction.
authors.affiliation: Department of Neurology, Dokkyo Medical University, Tochigi, Japan Department of Neurology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan Department of Clinical Medicine for Nursing, Dokkyo Medical University School of Nursing, Tochigi, Japan Department of Nephrology, Shimonoseki City Hospital, Yamaguchi, Japan Department of Neurology, Fujita Health University School of Medicine, Aichi, Japan Department of Pediatrics, Epilepsy Center, Nishi-Niigata Chuo National Hospital, Niigata, Japan Department of Neuropsychiatry, Akita University School of Medicine, Akita, Japan International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Suzuki
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Masayuki
authors.initials: M
authors.lastname: Miyamoto
authors.forename: Hiroto
authors.initials: H
authors.lastname: Maeda
authors.forename: Kazuya
authors.initials: K
authors.lastname: Nokura
authors.forename: Jun
authors.initials: J
authors.lastname: Tohyama
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shimizu
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanbayashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020643:Anterior Thalamic Nuclei / Q000098:blood supply; D002544:Cerebral Infarction / Q000134:cerebrospinal fluid*; D002908:Chronic Disease; D003128:Coma / Q000134:cerebrospinal fluid; D006970:Disorders of Excessive Somnolence / Q000134:cerebrospinal fluid*; D004292:Dominance, Cerebral / Q000502:physiology*; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000134:cerebrospinal fluid*; D008279:Magnetic Resonance Imaging; D008297:Male; D008636:Mesencephalon / Q000098:blood supply*; D008875:Middle Aged; D000068797:Orexins / Q000134:cerebrospinal fluid*; D020769:Posterior Cerebral Artery / Q000002:abnormalities*; D011379:Prognosis; D012189:Retrospective Studies; D013786:Thalamic Diseases / Q000134:cerebrospinal fluid*; D014851:Wakefulness / Q000502:physiology
chemical_list: D000068797:Orexins