Case Report of Secondary Narcolepsy Presenting as Self-Inflicted Genital Injury

Abstract

Primary Narcolepsy is a sleep disorder with classical presentation showing symptoms of cataplexy, excessive daytime sleepiness, sleep paralysis, and Hypnogogic hallucinations. A rare case of secondary narcolepsy was seen in a patient with self-inflicted genital injury. A 30 year old male was referred to Psychiatry from Surgery for a self-inflicted incised wound on hydrocoele. Since last 1 year, he had multiple episodes of - 1. Sudden falls while working 2. Sleep during daytime often at unusual places 3. Periods of unresponsiveness during which he was aware but unable to move. During hospital stay, daytime somnolence, sleep paralysis and cataplexy were noted several times, but hallucinations were not consistently reported. Based on DSM-IV-TR Narcolepsy was diagnosed. Possible reasons for genital injury were 1. To remove fluid from swelling 2. Under sleep paralysis 3. Under Hypnogogic hallucinations. Patient's EEG was normal. MRI brain showed Gliosis at cervico-medullary junction.MRI spine was advised to examine the cervico-vertebral junction but patient was lost to follow-up. But from history and investigations, it was concluded that he had secondary narcolepsy due to traumatic brain injury. Narcolepsy typically begins in young adulthood mainly 2nd decades of life and causes adverse effects on quality of life of patients. Diagnosis relies on history of patient and objective details obtained from polysomnography and multiple sleep latency testing. Main treatment is symptomatic relief through medication, psycho education , and behavioural modification.