DOI: https://doi.org/10.30654/MJCR.10063 Case Report MATHEWS JOURNAL OF CASE REPORTS 1 Citation: Javadpour A. (2020). Delayed appearance of Klein-Levin Syndrome caused by traumatic brain injury: A case report. Mathews J Case Rep. (5)1:63. ISSN :2474-3666 Vol No: 05, Issue: 01 Received Date: July 28, 2020 Published Date: October 20, 2020 Ali Javadpour 1 Shekoofeh Yaghmaei 2 * Nejla Mostafeenezhad 1 Nima Derakhshan 3 Peter Schofeld 4 1 Department of psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran 2 Shiraz University of Medical Sciences, Shiraz, Iran 3 Department of neurosurgery,Shiraz University of Medical Sciences, Shiraz, Iran 4 The university of Newcastle, Australia Shekoofeh Yaghmaei Medical Doctor, Shiraz University of Medical Sciences, Namazi Hospital, Namazi Square, Shiraz, Iran, Postal Code: 71937–11351, Tel/Fax: +98–713– 6474259 E-mail: yaghmaei.shekoofeh@gmail.com Delayed Appearance of Klein-Levin Syndrome Caused by Traumatic Brain Injury: A Case Report ABSTRACT Background: The combination of hypersomnia and any of: hyper-phagia, hyper-sexuality, or mood changes is known as Klein-Levin Syndrome. This syndrome is quite infrequent and mostly restricted to adolescent males. Case Description: A young patient with KLS is presented in this report. He was presented with relapsing-remitting hypersomnia and irritability more than two years after incurring a traumatic brain injury. Magnetic resonance imaging (MRI) showed hyperintensity in the posterolateral part of the right temporal region, matched with the brain injuries caused by the old trauma. His extremely long sleep episodes forced medical team to provide him with some necessary basic cares such as nasogastric tube and urinary catheter. Five consecutive weeks of taking modafnil got his sleep pattern back to normal. Conclusion: In addition to medical treatment which is inevitable for severe cases, family and social support is extremely vital for managing KLS patients. KEYWORDS: Klein-Levin syndrome; Traumatic brain injury; Sleep disorder; Modafnil ABBREVAIONS: KLS: Klein-Levin syndrome; TBI: Traumatic brain injury; GCS: Glasgow coma score; CT: Computed tomography; FAST: Sonography for trauma; MRS: Modifed Rankin scale; MRI: Magnetic resonance imaging; SPECT: Single photon emission computed tomography; FDG-PET: Fluorodeoxyglucose- positron emission tomography. BACKGROUND Klein-Levin syndrome (KLS) is a rare sleep disorder mainly afecting adolescent males. The exact pathophysiology of this disease is still unknown. However, some studies have shown it is accompanied by hypo-perfusion in the hypothalamus, thalamus and caudate nucleus [1]. KLS is characterized by relapsing-remitting episodes of severe hypersomnia and at least one of the followings symptoms: hyper-phagia, hyper-sexuality, mood changes and cognitive impairment [2]. Some patients also experienced apathy, derealization, and irritability. Several triggering factors have been suspected. Some patients report a prior history of upper respiratory tract infection, acute bronchitis or bronchiolitis. Alcohol consumption, head trauma, and mental stress are also suggested as factors precipitating KLS [3]. Mild and moderate traumatic brain injuries (TBI) coupled with other factors, while in cases of severe TBI the prominent factor is severity of the Corresponding Author: