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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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Full PDF
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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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  • Clinical Reasoning: A 45-year-old man with progressive insomnia and psychiatric and motor symptoms - August 18, 2020
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Article Information

vol. 94 no. 11 e1213-e1218
DOI: 
https://doi.org/10.1212/WNL.0000000000009098
PubMed: 
32107325

Published By: 
Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology
Print ISSN: 
0028-3878
Online ISSN: 
1526-632X
History: 
  • First Published February 27, 2020.

Article Versions

  • Previous version (February 27, 2020 - 12:45).
  • You are viewing the most recent version of this article.
Copyright & Usage: 
© 2020 American Academy of Neurology

Author Disclosures

    1. José Eduardo E. Lima, MD,
    2. Teddy S. Youn, MD,
    3. Christopher Robinson, DO, MS,
    4. Emily J. Gilmore, MD,
    5. Matthew Schrag, MD, PhD,
    6. Sirisha Sanamandra, MD and
    7. Carolina B. Maciel, MD, MSCR
  1. José Eduardo E. Lima, MD,
  2. Scientific Advisory Boards:
    1. NONE

    Gifts:
    1. NONE

    Funding for Travel or Speaker Honoraria:
    1. NONE

    Editorial Boards:
    1. NONE

    Patents:
    1. NONE

    Publishing Royalties:
    1. NONE

    Employment, Commercial Entity:
    1. NONE

    Consultancies:
    1. NONE

    Speakers' Bureaus:
    1. NONE

    Other Activities:
    1. NONE

    Clinical Procedures or Imaging Studies:
    1. NONE

    Research Support, Commercial Entities:
    1. NONE

    Research Support, Government Entities:
    1. NONE

    Research Support, Academic Entities:
    1. NONE

    Research Support, Foundations and Societies:
    1. NONE

    Stock/Stock Options/Board of Directors Compensation:
    1. NONE

    License Fee Payments, Technology or Inventions:
    1. NONE

    Royalty Payments, Technology or Inventions:
    1. NONE

    Stock/Stock Options, Research Sponsor:
    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:
    1. NONE

    Legal Proceedings:
    1. NONE

  3. Teddy S. Youn, MD,
  4. Scientific Advisory Boards:
    1. NONE

    Gifts:
    1. NONE

    Funding for Travel or Speaker Honoraria:
    1. NONE

    Editorial Boards:
    1. NONE

    Patents:
    1. NONE

    Publishing Royalties:
    1. NONE

    Employment, Commercial Entity:
    1. NONE

    Consultancies:
    1. NONE

    Speakers' Bureaus:
    1. NONE

    Other Activities:
    1. NONE

    Clinical Procedures or Imaging Studies:
    1. NONE

    Research Support, Commercial Entities:
    1. NONE

    Research Support, Government Entities:
    1. NONE

    Research Support, Academic Entities:
    1. NONE

    Research Support, Foundations and Societies:
    1. NONE

    Stock/Stock Options/Board of Directors Compensation:
    1. NONE

    License Fee Payments, Technology or Inventions:
    1. NONE

    Royalty Payments, Technology or Inventions:
    1. NONE

    Stock/Stock Options, Research Sponsor:
    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:
    1. NONE

    Legal Proceedings:
    1. NONE

  5. Christopher Robinson, DO, MS,
  6. Scientific Advisory Boards:
    1. NONE

    Gifts:
    1. NONE

    Funding for Travel or Speaker Honoraria:
    1. NONE

    Editorial Boards:
    1. NONE

    Patents:
    1. NONE

    Publishing Royalties:
    1. NONE

    Employment, Commercial Entity:
    1. NONE

    Consultancies:
    1. NONE

    Speakers' Bureaus:
    1. NONE

    Other Activities:
    1. NONE

    Clinical Procedures or Imaging Studies:
    1. NONE

    Research Support, Commercial Entities:
    1. NONE

    Research Support, Government Entities:
    1. NONE

    Research Support, Academic Entities:
    1. NONE

    Research Support, Foundations and Societies:
    1. NONE

    Stock/Stock Options/Board of Directors Compensation:
    1. NONE

    License Fee Payments, Technology or Inventions:
    1. NONE

    Royalty Payments, Technology or Inventions:
    1. NONE

    Stock/Stock Options, Research Sponsor:
    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:
    1. NONE

    Legal Proceedings:
    1. NONE

  7. Emily J. Gilmore, MD,
  8. Scientific Advisory Boards:
    1. NONE

    Gifts:
    1. NONE

    Funding for Travel or Speaker Honoraria:
    1. NONE

    Editorial Boards:
    1. NONE

    Patents:
    1. NONE

    Publishing Royalties:
    1. NONE

    Employment, Commercial Entity:
    1. NONE

    Consultancies:
    1. NONE

    Speakers' Bureaus:
    1. NONE

    Other Activities:
    1. NONE

    Clinical Procedures or Imaging Studies:
    1. NONE

    Research Support, Commercial Entities:
    1. NONE

    Research Support, Government Entities:
    1. NONE

    Research Support, Academic Entities:
    1. NONE

    Research Support, Foundations and Societies:
    1. NONE

    Stock/Stock Options/Board of Directors Compensation:
    1. NONE

    License Fee Payments, Technology or Inventions:
    1. NONE

    Royalty Payments, Technology or Inventions:
    1. NONE

    Stock/Stock Options, Research Sponsor:
    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:
    1. NONE

    Legal Proceedings:
    1. NONE

  9. Matthew Schrag, MD, PhD,
  10. Scientific Advisory Boards:
    1. I serve on the DSMB for the REVISION trial.

    Gifts:
    1. NONE

    Funding for Travel or Speaker Honoraria:
    1. NONE

    Editorial Boards:
    1. NONE

    Patents:
    1. I hold several patents which are unrelated to the current work.

    Publishing Royalties:
    1. NONE

    Employment, Commercial Entity:
    1. NONE

    Consultancies:
    1. NONE

    Speakers' Bureaus:
    1. NONE

    Other Activities:
    1. NONE

    Clinical Procedures or Imaging Studies:
    1. NONE

    Research Support, Commercial Entities:
    1. NONE

    Research Support, Government Entities:
    1. Agency: NIH Period: 07/01/2019-06/30/2024 Project role: PI Amount: $1,215,000 Grant number: NIA K76 AG060001 Agency: NIH Period: 07/01/2018-06/30/2020 Project role: Collaborator Amount: $235,000 Grant number: 1R21NS106510-01

    Research Support, Academic Entities:
    1. Agency: Vanderbilt University Period: 03/15/2017-03/15/2020 Project role: PI Amount: $330,000 Grant number: U6282

    Research Support, Foundations and Societies:
    1. NONE

    Stock/Stock Options/Board of Directors Compensation:
    1. NONE

    License Fee Payments, Technology or Inventions:
    1. NONE

    Royalty Payments, Technology or Inventions:
    1. NONE

    Stock/Stock Options, Research Sponsor:
    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:
    1. NONE

    Legal Proceedings:
    1. NONE

  11. Sirisha Sanamandra, MD and
  12. Scientific Advisory Boards:
    1. NONE

    Gifts:
    1. NONE

    Funding for Travel or Speaker Honoraria:
    1. NONE

    Editorial Boards:
    1. NONE

    Patents:
    1. NONE

    Publishing Royalties:
    1. NONE

    Employment, Commercial Entity:
    1. NONE

    Consultancies:
    1. NONE

    Speakers' Bureaus:
    1. NONE

    Other Activities:
    1. NONE

    Clinical Procedures or Imaging Studies:
    1. NONE

    Research Support, Commercial Entities:
    1. NONE

    Research Support, Government Entities:
    1. NONE

    Research Support, Academic Entities:
    1. NONE

    Research Support, Foundations and Societies:
    1. NONE

    Stock/Stock Options/Board of Directors Compensation:
    1. NONE

    License Fee Payments, Technology or Inventions:
    1. NONE

    Royalty Payments, Technology or Inventions:
    1. NONE

    Stock/Stock Options, Research Sponsor:
    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:
    1. NONE

    Legal Proceedings:
    1. NONE

  13. Carolina B. Maciel, MD, MSCR
  14. Scientific Advisory Boards:
    1. NONE

    Gifts:
    1. NONE

    Funding for Travel or Speaker Honoraria:
    1. NONE

    Editorial Boards:
    1. (1) eNeurologicalSci journal, assistant editor, 2 years.

    Patents:
    1. NONE

    Publishing Royalties:
    1. NONE

    Employment, Commercial Entity:
    1. NONE

    Consultancies:
    1. NONE

    Speakers' Bureaus:
    1. NONE

    Other Activities:
    1. NONE

    Clinical Procedures or Imaging Studies:
    1. NONE

    Research Support, Commercial Entities:
    1. NONE

    Research Support, Government Entities:
    1. NONE

    Research Support, Academic Entities:
    1. NONE

    Research Support, Foundations and Societies:
    1. NONE

    Stock/Stock Options/Board of Directors Compensation:
    1. NONE

    License Fee Payments, Technology or Inventions:
    1. NONE

    Royalty Payments, Technology or Inventions:
    1. NONE

    Stock/Stock Options, Research Sponsor:
    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:
    1. NONE

    Legal Proceedings:
    1. NONE

  1. 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.
  1. Correspondence
    Dr. Maciel Carolina.Maciel{at}neurology.ufl.edu
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Cited By...

  • 1 Citations
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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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