Sleep-Related Laryngospasm Caused by Gastroesophageal Reflux

Sleep-related laryngospasm is a rare cause of sleep-related breathing disturbance which produce stridor or interruption of airflow associated with a distinct polysomnography arousal pattern. We report a case of a sixty-five-year-old woman who was referred for awakenings with abrupt respiratory distress and fear of suffocation. A polysomnography showed a total or near-total cessation of airflow, followed by choking and stridor for several minutes with a rapid increase in heart rate. Temporary hoarseness was seen. The esophageal pH monitoring indicated acid reflux, which confirmed gastroesophageal reflux disease. The protonpump inhibitor eliminated the sleep-related laryngospasm.

Positive Sleep State Misperception Mimicking Hypersomnia

A condition of underestimation of sleep is classified as paradoxical insomnia or sleep state misperception. However, overestimation of sleep, so called positive sleep state misperception has not been clearly described. Here we report a middle-aged woman with positive sleep state misperception who presented excessive sleepiness mimicking hypersomnia.

Two-year Prospective Study of Seizure Recurrence in Newly Diagnosed Partial Epilepsy: Can MRI Predict the Recurrence of Seizure?

BACKGROUND: It has been known that several factors are associated with seizure recurrence. We performed this study to determine whether an MRI can independently predict seizure recurrence in newly diagnosed partial epilepsy. METHODS: We found 91 newly diagnosed partial epilepsy patients with whom we prospectively followed up for at least 2 years. Variables for statistical analysis were cumulative recurrence rates according to MRI findings as well as age of onset, etiology and epilepsy syndrome. We divided MRI findings into paired groups of normal and abnormal groups, age of onset into or =28 years groups, etiology into symptomatic and cryptogenic groups and epilepsy syndrome into temporal lobe epilepsy and extratemporal lobe epilepsy groups respectively. RESULTS: The seizure recurrence rate was 24% at 1 year and 36% at 2 years follow-up. Among prognostic variables, the epilepsy syndrome, etiology and MRI findings could significantly predict the seizure recurrence at 2 years but age of onset could not predict recurrence at 2 years follow-up. Univariate analysis showed the odds ratio of the seizure recurrence as follows: temporal lobe epilepsy was 1.91 (95%CI 0.89~4.12), symptomatic etiology was 2.27 (95%CI 1.13~4.57), abnormal MRI finding was 2.80 (1.40~5.60). Multivariate analyses showed that only abnormal MRI findings could independently predict the seizure recurrence. CONCLUSIONS: We conclude that abnormal MRI finding can independently predict seizure recurrence at 2 years follow-up.

Reversible Posterior Leukoencephalopathy Syndrome(RPLS): with special reference to Brain MRA

Reversible posterior leukoencephalopathy syndrome (RPLS) is noted by a reversible syndrome of headache, altered mental function, seizures, and loss of vision associated with findings indicating predominantly posterior leukoen-cephalopathy on imaging studies. Reversible vasospasm and brain capillary leak syndrome are usually suggested to the pathophysiologic mechanism of RPLS. We report 6 patients with RPLS, which showed peculiar findings in the MRA.