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Observation | Oct 2012

Hypothermia, Hypotension, Hypersomnia, and Obesity Associated With Hypothalamic Lesions in a Patient Positive for the Anti–aquaporin 4 Antibody: A Case Report and Literature Review

Keisuke Suzuki, MD, PhD; Toshiki Nakamura, MD, PhD; Kenichi Hashimoto, MD; Masayuki Miyamoto, MD, PhD; Tomoko Komagamine, MD; Takahide Nagashima, MD, PhD; Naoki Izawa, MD; Takashi Kanbayashi, MD, PhD; Toshiyuki Takahashi, MD, PhD; Koichi Hirata, MD, PhD

Arch Neurol. 2012;69(10):1355-1359. doi:10.1001/archneurol.2012.300.

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ABSTRACT | REPORT OF A CASE | COMMENT | AUTHOR INFORMATION | REFERENCES

Objective To describe a patient positive for the anti–aquaporin 4 antibody with hypothalamic lesions showing hypothermia, hypotension, hypersomnia, and obesity.

Design Case report.

Setting University hospital.

Patient We describe a 21-year-old woman who was positive for anti–aquaporin 4 antibody and presented with hypothermia, hypotension, and hypersomnia owing to bilateral hypothalamic lesions as the only abnormal clinical finding.

Results Immediate steroid administration resulted in significant improvement of the patient's vital signs and imaging findings; however, her cognitive impairment and sleepiness persisted, and she subsequently developed obesity. Decreased cerebrospinal fluid orexin levels and sleep studies confirmed the diagnosis of narcolepsy due to medical condition. Physicians should be aware that neuromyelitis optica spectrum disorders can initially involve the hypothalamus.

Conclusions We emphasize that measurement of anti–aquaporin 4 antibody is of clinical importance in the differential diagnosis of hypothalamic lesions.

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Figure. Fluid-attenuated inversion recovery (FLAIR) images of brain magnetic resonance imaging (MRI). On hospital admission, FLAIR MRI showed bilateral high signal intensity lesions in the hypothalamus involving the bilateral thalamus (A and D). A follow-up FLAIR MRI on day 30 showed a significant reduction in the high signal intensities, except for the lesions surrounding the third ventricle (B, E, and G). On follow-up MRI at 3 months, the hypothalamic lesions completely disappeared, but a dilated third ventricle was noted (C, F, and H). The left side of the images indicate the right side of the brain.

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Suzuki K, Nakamura T, Hashimoto K, et al. Hypothermia, Hypotension, Hypersomnia, and Obesity Associated With Hypothalamic Lesions in a Patient Positive for the Anti–aquaporin 4 Antibody: A Case Report and Literature Review. Arch Neurol. 2012;69(10):1355-1359. doi:10.1001/archneurol.2012.300.

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Hypothermia, Hypotension, Hypersomnia, and Obesity Associated With Hypothalamic Lesions in a Patient Positive for the Anti–aquaporin 4 Antibody: A Case Report and Literature Review

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