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March 17, 2020; 94 (11) Resident & Fellow Section

Clinical Reasoning: A 45-year-old man with progressive insomnia and psychiatric and motor symptoms

José Eduardo E. Lima, View ORCID ProfileTeddy S. Youn, Christopher Robinson, Emily J. Gilmore, View ORCID ProfileMatthew Schrag, Sirisha Sanamandra, View ORCID ProfileCarolina B. Maciel
First published February 27, 2020, DOI: https://doi.org/10.1212/WNL.0000000000009098
José Eduardo E. Lima
From the Ribeirão Preto Medical School (J.E.E.L.), University of São Paulo, Brazil; Department of Neurology (T.S.Y., C.R., C.B.M.), UF Health Shands Hospital, University of Florida College of Medicine, Gainesville; Department of Neurology (E.J.G., S.S., C.B.M.), Yale University School of Medicine, New Haven, CT; and Department of Neurology (M.S.), Vanderbilt University Medical Center, Nashville, TN.
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Teddy S. Youn
From the Ribeirão Preto Medical School (J.E.E.L.), University of São Paulo, Brazil; Department of Neurology (T.S.Y., C.R., C.B.M.), UF Health Shands Hospital, University of Florida College of Medicine, Gainesville; Department of Neurology (E.J.G., S.S., C.B.M.), Yale University School of Medicine, New Haven, CT; and Department of Neurology (M.S.), Vanderbilt University Medical Center, Nashville, TN.
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  • ORCID record for Teddy S. Youn
Christopher Robinson
From the Ribeirão Preto Medical School (J.E.E.L.), University of São Paulo, Brazil; Department of Neurology (T.S.Y., C.R., C.B.M.), UF Health Shands Hospital, University of Florida College of Medicine, Gainesville; Department of Neurology (E.J.G., S.S., C.B.M.), Yale University School of Medicine, New Haven, CT; and Department of Neurology (M.S.), Vanderbilt University Medical Center, Nashville, TN.
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Emily J. Gilmore
From the Ribeirão Preto Medical School (J.E.E.L.), University of São Paulo, Brazil; Department of Neurology (T.S.Y., C.R., C.B.M.), UF Health Shands Hospital, University of Florida College of Medicine, Gainesville; Department of Neurology (E.J.G., S.S., C.B.M.), Yale University School of Medicine, New Haven, CT; and Department of Neurology (M.S.), Vanderbilt University Medical Center, Nashville, TN.
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Matthew Schrag
From the Ribeirão Preto Medical School (J.E.E.L.), University of São Paulo, Brazil; Department of Neurology (T.S.Y., C.R., C.B.M.), UF Health Shands Hospital, University of Florida College of Medicine, Gainesville; Department of Neurology (E.J.G., S.S., C.B.M.), Yale University School of Medicine, New Haven, CT; and Department of Neurology (M.S.), Vanderbilt University Medical Center, Nashville, TN.
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Sirisha Sanamandra
From the Ribeirão Preto Medical School (J.E.E.L.), University of São Paulo, Brazil; Department of Neurology (T.S.Y., C.R., C.B.M.), UF Health Shands Hospital, University of Florida College of Medicine, Gainesville; Department of Neurology (E.J.G., S.S., C.B.M.), Yale University School of Medicine, New Haven, CT; and Department of Neurology (M.S.), Vanderbilt University Medical Center, Nashville, TN.
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Carolina B. Maciel
From the Ribeirão Preto Medical School (J.E.E.L.), University of São Paulo, Brazil; Department of Neurology (T.S.Y., C.R., C.B.M.), UF Health Shands Hospital, University of Florida College of Medicine, Gainesville; Department of Neurology (E.J.G., S.S., C.B.M.), Yale University School of Medicine, New Haven, CT; and Department of Neurology (M.S.), Vanderbilt University Medical Center, Nashville, TN.
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Citation
Clinical Reasoning: A 45-year-old man with progressive insomnia and psychiatric and motor symptoms
José Eduardo E. Lima, Teddy S. Youn, Christopher Robinson, Emily J. Gilmore, Matthew Schrag, Sirisha Sanamandra, Carolina B. Maciel
Neurology Mar 2020, 94 (11) e1213-e1218; DOI: 10.1212/WNL.0000000000009098

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This article has a correction. Please see:

  • Clinical Reasoning: A 45-year-old man with progressive insomnia and psychiatric and motor symptoms - August 18, 2020
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A 45-year-old right-handed hypertensive man presented with a 6-month history of worsening neuropsychiatric symptoms, abnormal movements, and weight loss. He was hallucinating, apathetic, and having severe insomnia (total sleep duration of 1–2 hours/night). During sleep, his wife noted labored and sonorous breathing. Six months before admission, he led a healthy and active lifestyle.

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  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • © 2020 American Academy of Neurology
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Letters: Rapid online correspondence

  • Author response: Clinical Reasoning: A 45-year-old man with progressive insomnia and psychiatric and motor symptoms
    • Carolina Maciel, MD, MSCR, Neurointensivist and Critical Care Encephalographer, University of Florida
    • Jose Eduardo E. Lima, MD, Ribeirão Preto Medical School
    Submitted April 07, 2020
  • Reader response: Clinical Reasoning: A 45-year-old man with progressive insomnia and psychiatric and motor symptoms
    • Carlos Singer, Professor of Neurology, University of Maimi
    • Jason Margolesky, Assistant Professor of Neurology, University of Miami
    Submitted March 30, 2020
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