Nature and Science of Sleep (Nov 2023)
Symptomatic, Drug-Resistant Narcolepsy Remission After Fenestration of an Arachnoid Cyst – A Case Report
Abstract
Erika CS Künstler,1,2 Matthias Schwab,1,2 Henry WS Schroeder,3 Sven Rupprecht1,2 1Department of Neurology, Jena University Hospital, Jena, Germany; 2Interdisciplinary Centre for Sleep and Ventilatory Medicine, Jena University Hospital, Jena, Germany; 3Department of Neurosurgery, University Medicine Greifswald, Greifswald, GermanyCorrespondence: Erika CS Künstler, Department of Neurology, Jena University Hospital, Am Klinikum 1, Jena, D-07747, Germany, Tel +49 3641 9323525, Email [email protected]: The pathogenesis of different narcolepsy phenotypes remains unclear. In rare cases, narcolepsy can be attributable to secondary brain pathologies affecting the midbrain. These cases may elucidate the pathological background and the treatment of narcolepsy, but are often limited by poor objective symptom characterization and effects of therapeutic intervention, especially by modern diagnostic standards.Methods: A young adult presented with excessive daytime sleepiness (EDS) that was refractory to classic narcolepsy medication. Diagnosis of narcolepsy was made based on the pathologically shortened sleep latencies in polysomnography and Multiple Sleep Latency Test (MSLT), together with confirmed sleep-onset REM-sleep (SOREM). Preserved hypocretin levels in cerebrospinal fluid, together with the absence of cataplectic events confirmed the diagnosis of narcolepsy type II. MRI revealed a large arachnoid cyst with compression of the midbrain.Results: Six months after fenestration of the cyst, the patient’s EDS had vastly improved. No further SOREM was observed, and polysomnographic and MSLT sleep latencies normalized. No further drug treatment was required.Conclusion: Symptomatic narcolepsy due to space-occupying lesions in the mesencephalon comprises a unique curative treatment option. Here, surgical intervention offers an effective curative therapeutic approach. However, differential diagnosis of symptomatic narcolepsy requires special consideration.Keywords: symptomatic narcolepsy, arachnoid cyst, excessive daytime sleepiness, remission, case report
