Case Report of Secondary Narcolepsy Presenting as Self-Inflicted Genital Injury

Abstract

Primary Narcolepsy is a sleep disorder with classical presentation showing symptoms of cataplexy, excessive daytime sleepiness, sleep paralysis, and Hypnogogic hallucinations. A rare case of secondary narcolepsy was seen in a patient with self-inflicted genital injury. A 30 year old male was referred to Psychiatry from Surgery for a self-inflicted incised wound on hydrocoele. Since last 1 year, he had multiple episodes of -- 1. Sudden falls while working 2. Sleep during daytime often at unusual places 3. Periods of unresponsiveness during which he was aware but unable to move. During hospital stay, all symptoms of Narcolepsy were noted several times, but prominent hallucinations were not consistently reported. Patient’s EEG was normal. MRI brain showed Gliosis at cervicomedullary junction.MRI spine was advised to examine the cervico-vertebral junction but patient was lost to follow-up. But from historyand investigations, based on DSM-IV-TR, Narcolepsy was diagnosed. It was concluded that he had secondary narcolepsy due to traumatic brain injury. As Self Inflicted Genital injury was done after hallucinations and sleep attack, it was considered to be part of Narcolepsy -a rare presentation. Narcolepsy typically begins in young adulthood mainly 2nd decades of life and causes adverse effects on quality of life of patients. Diagnosis relies on history of patient and objective details obtained from polysomnography and multiple sleep latency testing. Main treatment is symptomatic relief through medication, psycho education, and behavioural modification.