ID 426 – Nightmares as form of manifestation of brainstem glioma

Abstract

Objective Nightmares are parasomnias described as vivid and terrifying events that usually lead to awakening and difficult returning to sleep. Dreamers are able to remember the episode. They generally occur during REM sleep, in the second half of the night. Methods We present the case of a 27 year-old girl referred to the Sleep Unit due to the presence of recurrent nightmares of a year of evolution, associated with unrefreshing sleep and daytime sleepiness. The patient’s partner referred also occasional vocalizations and minimal motor phenomena during sleep. Results The polysomnographic study showed REM sleep without atonia. A MRI was asked to evaluate the integrity of brainstem nuclei associated with muscle atonia during REM sleep. It showed an infiltrative lesion of the pons and spinal bulb compatible with a diffuse intrinsic pontine glioma (DIPG). Conclusions Although nightmares are common parasomnias usually related to psychological causes, organic disorders should also be taken into account when associated with alterations in the polysomnographic study. Key message Nightmares are common phenomena usally not associated with polysomnographic alteractions. REM sleep without atonia is always abnormal and it is mandatory to perform neuroimaging studies to evaluate the integrity of REM sleep generators in the brainstem.