Visual hallucinations and pontine demyelination in a child: possible REM dissociation?
Maria Gabriella Vita, Anna Paola Batocchi, Serena Dittoni, Anna Losurdo, Alessandro Cianfoni, Maria Chiara Stefanini, Catello Vollono, Giacomo Della Marca, Paolo Mariotti
Journal of Clinical Sleep Medicine December 1, 2008 DOI: 10.5664/jcsm.27355 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | An 11-year-old boy with acute hallucinations |
| Intervention | Immunoglobulins |
| Duration | Hallucinations persisted for 3 days |
| Measures | Ictal EEG, MRI, Polysomnography, Multiple sleep latency test |
| Keywords | Brain stem Pons Humans Demyelinating diseases Hallucinations Diagnosis, differential Magnetic resonance imaging Polysomnography Sleep, rem Dissociative disorders Psychotic disorders Child Male |
| Key findings | The authors propose that this boy's three days of complex visual and acoustic hallucinations, including visions of a threatening Harry Potter character, resulted from inflammatory brainstem lesions in the pontine tegmentum that transiently impaired REM sleep inhibitory mechanisms, allowing dream-like hallucinations to occur during wakefulness. |
Abstract
An 11 year-old-boy acutely developed complex visual and acoustic hallucinations. Hallucinations, consisting of visions of a threatening, evil character of the Harry Potter saga, persisted for 3 days. Neurological and psychiatric examinations were normal. Ictal EEG was negative. MRI documented 3 small areas of hyperintense signal in the brainstem, along the paramedian and lateral portions of pontine tegmentum, one of which showed post-contrast enhancement. These lesions were likely of inflammatory origin, and treatment with immunoglobulins was started. Polysomnography was normal, multiple sleep latency test showed a mean sleep latency of 8 minutes, with one sleep-onset REM period. The pontine tegmentum is responsible for REM sleep regulation, and contains definite "REM-on" and "REM-off" regions. The anatomical distribution of the lesions permits us to hypothesize that hallucinations in this boy were consequent to a transient impairment of REM sleep inhibitory mechanisms, with the appearance of dream-like hallucinations during wake.