Case Presentation:
Chief Complaints
A 33-year-old woman presented to the outpatient neurology clinic
complaining from episodes of falling asleep during the daytime despite
about 8.5 hours of sleep per night.
History of Present Illness
She was a psychologist and she noticed that she could not concentrate on
the statements of her clients and that she sometimes saw some dream-like
images around them. She also noted increasing lethargy, drowsiness and
an irresistible urge to fall asleep many times a day even during
conversations, while at work, or driving her car. All of her symptoms
had begun immediately after recovery from COVID-19 about nine months
before her presentation to neurology clinic. She reported that her
symptoms of COVID-19 included fatigue, diarrhea, myalgia, hyposmia and
hypogeusia without respiratory symptoms. She had recovered from COVID-19
with supportive and symptom-based treatment.
The patient also complained of frightening visual and auditory
hallucinations while falling asleep at night as well as daytime. She had
frequently experienced episodes of paralysis in which she was unable to
move her body for a few seconds after awakening. She also complained
from a sense of muscle weakness associated with drooping of eyelids,
brought on by extreme emotions (e.g. laughing, shouting or any severe
mental stress).
History of Past Illness
Her medical history was unremarkable. There was no history of chronic
sleep disorders, restless leg syndrome, sleep apnea, and head trauma or
medication abuse.
Personal and Family
History
She did not use any substance or drugs. There was no history of sleep
disorders in her family history.
Physical Examination
Upon physical examination, she was a young woman with average body
habitus (60 kg, 160 cm and BMI23.4 kg/m 2). She did not appear ill or
drowsy during the history taking and physical examination. The
pharyngeal lumen was patent. There were no craniofacial risk factors for
sleep apnea such as retrognathia. She had neither ptosis, nor weakness
of facial or limb muscles. The remainder of general physical and
neurological examinations were unremarkable.
Laboratory and Imaging
Studies
In addition, routine blood tests and brain magnetic resonance imaging
(MRI) revealed no significant pathology. The patient was referred for a
polysomnograhic study at a sleep clinic the results of which are
presented in table 1.