PT  - JOURNAL ARTICLE
AU  - Elisabet Londos
AU  - Oskar Hansson
AU  - Ingmar Rosén
AU  - Elisabet Englund
TI  - Extreme sleep pattern in Lewy body dementia: a hypothalamic matter?
AID  - 10.1136/bcr-2018-228177
DP  - 2019 Mar 01
TA  - BMJ Case Reports
PG  - e228177
VI  - 12
IP  - 3
4099  - http://casereports.bmj.com/content/12/3/e228177.short
4100  - http://casereports.bmj.com/content/12/3/e228177.full
SO  - BMJ Case Reports2019 Mar 01; 12
AB  - Excessive sleep during the night and for >2 hours during the day is part of the fluctuating wakefulness criterion of dementia with Lewy bodies (DLB). The phenomenon ‘sleep days’ is not uncommon in nursing homes. Here, we describe a woman who, for months, slept for 3 days and nights in a row and thereafter was awake for 3 days and nights. Electroencephalogram (EEG) showed slow background activity and increased delta activity. No epileptiform activity was detected. Polysomnography showed a severely disturbed, markedly fragmented sleep pattern. On her death, neuropathology revealed degeneration and loss of neurons along with α-synuclein-containing Lewy body inclusions and neurites in the substantia nigra, locus coeruleus, hypothalamus, and neocortex, thus fulfilling the criteria of DLB, cortical type. We propose that the hypothalamic degeneration contributed significantly to the clinical profile in this case. We suggest that patients with sleep days should be investigated for other DLB signs.