0812 Periodic Limb Movements in the Setting of Pediatric Traumatic Brain Injury

Abstract

Introduction: Sleep disturbances following traumatic brain injury (TBI) are commonly diagnosed and can affect up to 70% of individuals, with many occurring after mild injuries such as concussions. 1 Patients can experience a variety of sleep problems such as sleep-wake disturbances, infrequent parasomnias, and periodic limb movement disorders. While periodic limb movements (PLMs) can occur in pediatric patients, they are rare compared to their adult counterparts. Literature is limited regarding the presence of PLMs post-concussion in the pediatric population. We describe an unusual case of PLMs in the setting of mild TBI in a pediatric patient. Report of Cases: A 6-year-old male with a past medical history significant for adeno-tonsillar hypertrophy and chronic cough was brought to the emergency department by ambulance after being found facedown secondary to a fall at school. Physical examination findings were significant for dried blood at the nares with an abrasion to the anterior nasal bridge. No other signs of trauma were noted, and his Glasgow Coma Scale (GCS) was 15. Computerized Tomography (CT) scan of the head was negative for any acute intracranial abnormality. He was diagnosed with a mild TBI and sent home with concussion precautions. Prior to his concussion, at the age of 4, he was diagnosed with obstructive sleep apnea (OSA) via polysomnography (PSG). Moderate OSA was noted with an apnea hypopnea index (AHI) of 8.1 per hour leading to adenotonsillectomy. Five weeks after his concussion, an evaluation by the pediatrician revealed complaints of restless sleep and worsened emotional lability prompting a referral to the sleep clinic. By comparison, the patient's post-TBI PSG at age 6 showed no evidence of sleep-disordered breathing (AHI of 1.48 per hour) but with new periodic limb movements and an elevated PLM index of 6.56 per hour. An iron panel is pending. Conclusion: PLMs in the setting of pediatric TBI is a rarely diagnosed entity and, to our knowledge, has never been reported in the literature. Our case suggests that clinicians should have a high level of suspicion for sleep problems post-TBI and consider PSG to assess for PLMs which can affect recovery and the overall qualityof- life of the pediatric patient.