A case of unexplained episodic loss of consciousness.
نویسندگان
چکیده
T patient was a 49-year-old man with no significant past medical history, normal body mass index, and normal oral/ nasal airway anatomy, who presented with a 4-month history of episodic loss of consciousness while working as a cemetery caretaker. The patient lost consciousness while using a riding lawnmower at the cemetery during his morning landscaping duties; this caused him to lean forward in his seat. The riding lawnmower would then hit a headstone, and the jarring impact caused him to “come to.” He experienced these episodes approximately 10 to 20 times a month. The patient denied associated jerking, posturing, or staring with these episodes. Prior to our evaluation, the patient was evaluated by an internist and found to have normal serum metabolite levels, complete blood count, and electrocardiogram. The patient had two daily jobs. He worked as a cemetery caretaker from 06:00 to 14:30. His second job was as a bank janitor from 17:30 to 20:30. He returned home by 21:30 and went to bed at 22:30. Before going to bed, the patient watched television or used his personal computer to go onto the internet. Once in bed, his ability to get to sleep was often disrupted by noisy neighbors. This environmental disturbance made it difficult to get into stable sleep most nights. A typical week’s sleep log is shown in Fig. 1. He denied witnessed snoring or apneas, leg jerking or cramping, lower extremity dysesthesias, cataplexy, sleep paralysis, and hypnagogic/hypnopompic hallucinations. The patient reported excessive daytime sleepiness and would fall asleep while sitting quietly or watching television. The patient drank approximately six 12-ounce cans of caffeinated soda per day, but none after 18:00. He took a refreshing 20-minute nap during his lunch break. On the weekends, he attempted to catch up on his sleep by sleeping later and taking naps during the day.
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ورودعنوان ژورنال:
- Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
دوره 4 5 شماره
صفحات -
تاریخ انتشار 2008