Visual hallucinations and pontine demyelination in a child: possible REM dissociation?

J Clin Sleep Med. 2008 Dec 15;4(6):588-90.

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.

Publication types

  • Case Reports

MeSH terms

  • Brain Stem / pathology*
  • Child
  • Demyelinating Diseases / complications*
  • Diagnosis, Differential
  • Dissociative Disorders / etiology
  • Dissociative Disorders / physiopathology
  • Hallucinations / etiology*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Polysomnography
  • Pons / physiology*
  • Psychotic Disorders / etiology
  • Psychotic Disorders / physiopathology
  • Sleep, REM / physiology*