1122 Acute onset status cataplecticus in an elderly man originally diagnosed with syncope

Abstract

Introduction: Narcolepsy with cataplexy can be the great masquerader of patient complaints with a diverse spectrum of presentations. We report acute onset status cateplecticus in a 64 year old gentleman with no prior history of a central hypersomnolence disorder. This case highlights the need for consideration of central hypersomnolence disorders secondary to a medical condition in the differential diagnosis of syncope. Report of Case: 64 year-old patient, noted to have acute onset of paroxysmal episodes of loss of consciousness (LOC) presented to the emergency department. He denied prior history of syncope and noted a severe headache, dysarthria, and blurry vision preceding the onset of the episodes. The patient described predictable paroxysmal episodes of LOC in response to strong emotion. At an episode onset, he described relaxation of facial muscles that progressed into relaxation of lower extremity muscles, followed by a few seconds of LOC. The patient related that he could quickly return to consciousness without confusion if someone was present to rouse him. While hospitalized, he underwent a comprehensive work up for syncope that did not elucidate a discreet etiology for the episodes of LOC. Polysomnography and multiple sleep latency test (MSLT) were later performed and suggestive of narcolepsy with cataplexy with mean sleep onset latency of 2 minutes and 45 seconds and 4 sleep onset REM periods. The paroxysmal episodes the patients had described were captured on video-electroencephalography EEG monitoring in between the nap trials of his MSLT. MRI of the brain revealed white matter changes in the hypothalmus. Conclusion: Narcolepsy with cataplexy due to a medical condition (NDMC) has been documented in patients with multiple sclerosis when plaques impair the hypothalamus, paraneoplastic syndrome, and Niemann-Pick type C disease. This case demonstrates a unique presentation of NDMC and highlights the need to consider central hypersomnolence disorders in the differential diagnosis even in advanced age populations.