Night terrors associated with thalamic lesion Giancarlo Di Gennaro a, * , Alain Autret b , Addolorata Mascia a , Paolo Onorati c,d , Fabio Sebastiano a , Pier Paolo Quarato a a Epilepsy Surgery Unit, Department of Neurosciences, IRCCS Neuromed, via Atinense, n 18,Pozzilli (IS) 86077, Italy b Service de Neurologie, CHU Bretonneau, Tours 37044, France c Department of Human Physiology and Pharmacology, University ‘La Sapienza’, Rome, Italy d Pediatric, Adult and Developmental Center, San Raffaele Pisana-Tosinvest Sanita `, Rome, Italy Accepted 30 May 2004 Available online 17 July 2004 Abstract Objective: To describe a case with night terrors (NT) symptomatic of a thalamic lesion. Methods: Videopolysomnography and brain MRI were used to study a 48 year old woman with a recent onset of brief episodes, occurring exclusively during nocturnal sleep, where she suddenly sat up in bed, screamed and appeared to be very frightened. Results: Videopolysomnography recorded an episode suggestive of NT. Sleep fragmentation with frequent brief arousals or microarousals was also evident mainly during slow wave sleep. The brain MRI showed increased T2 signal from the right thalamus suggestive of a low- grade tumor. Conclusions: Our case suggests that NT starting in adulthood can, rarely, be symptomatic of neurological disease, and warrant further investigation with MRI. Significance: A thalamic dysfunction, disrupting at this level the arousal system, may play a role in provoking NT. q 2004 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved. Keywords: Night terrors; Polysomnography; Thalamic lesion A 48 year old woman was admitted at our Epilepsy Unit for a 2-year history of brief, non-stereotypical episodes, occurring exclusively during nocturnal sleep, where she suddenly sat up in bed, screamed and appeared to be very frightened, confused and unresponsive. During these attacks, which occurred weekly, she was agitated and would try to embrace her husband. After some minutes, she promptly fell back to sleep. The patient had no memory of the event in the morning. Family history was negative for epilepsy, sleep disorders and other neurological diseases. Full-term birth was uncomplicated and first psychomotor developmental mile- stones were normal. In the past medical history, there were no neurological and psychiatric disorders. In particular, the patient did not report night terrors (NT) or sleep walking during childhood. General and neurological examinations were normal. Psychiatric clinical interview and psychometric tests (Minnesota Multiphasic Inventory II, State Trait Anxiety Inventory, State Trait Anger Expression Inventory, Beck Depression Inventory) revealed no signs of psychopathol- ogy or personality disturbance. The MRI scan of the brain showed increased T2 signal from the right thalamus suggestive of a low grade tumor (Fig. 1). Awake standard EEG revealed mild theta abnormalities localized over the right frontal-central regions. A 24-h video-EEG monitoring including polygraphy (EKG, EOG, mylohyoid and right tibial anterior EMG) showed normal wake/sleep activities. Night sleep was mainly characterized by light sleep stages, though all stages were evident. Sleep figures (spindles and K complexes) were asymmetrical, as there was a clear left-side predomi- nance (Fig. 2). Sleep fragmentation with frequent brief arousals or microarousals was also evident mainly during slow wave sleep (SWS). However, the total sleep time, as evaluated during Videopolisomnography, was within the normal range (460 min). No epileptiform abnormalities were observed. 1388-2457/$30.00 q 2004 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.clinph.2004.05.029 Clinical Neurophysiology 115 (2004) 2489–2492 www.elsevier.com/locate/clinph * Corresponding author. Tel.: þ 39-865-929528; fax: þ 39-865-925351. E-mail address: gdigennaro@neuromed.it (G. Di Gennaro).