Papilledema and Seizure like Episodes in a Patient with Obstructive Sleep Apnea Syndrome: A Case Presentation and Literature Review
Abstract
Background and Objective: Obstructive sleep apnea (OSA) syndrome is a common sleep-related breathing disorder characterized by repeated episodes of the upper airway collapse during sleep. Loud snoring and daytime sleepiness are the main complaints; however, the condition may present with a variety of symptoms and signs.
Case Report: A 65-year-old woman was admitted to neurology ward with the diagnosis of intractable seizures. The physical examination revealed papilledema and huge obesity with body mass index of 41. Brain imaging was unremarkable. The pressure of cerebrospinal fluid was 33 cm H2O. As respiratory distress was observed, pulmonary evaluations were conducted. Finally, an overnight polysomnography confirmed the diagnosis of severe OSA. Positive airway pressure removed the symptoms.
Conclusion: This presentation suggests that severe OSA should be considered as a differential diagnosis for epilepsy and a probable cause of raised intracranial pressure, especially at the presence of obesity.
Yaggi HK, Concato J, Kernan WN, et al. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005; 353: 2034-41.
McNicholas WT, Bonsigore MR. Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur Respir J 2007; 29: 156-78.
American Sleep Disorders Association, Diagnostic Classification Steering Committee. The international classification of sleep disorders: diagnostic and coding manual. Washington, DC: American Sleep Disorders Association, 2005: 52-8
Lurie A. Cardiovascular disorders associated with obstructive sleep apnea. Adv Cardiol 2011; 46:197-266.
Kielb SA, Ancoli-Israel S, Rebok GW, et al. Cognition in obstructive sleep apnea-hypopnea syndrome (OSAS): current clinical knowledge and the impact of treatment. Neuromolecular Med 2012; 14:180-93.
Galecki P, Florkowski A, Zboralski K, et al. Psychiatric and psychological complications in obstructive sleep apnea syndrome. Pneumonol Alergol Pol 2011; 79: 26-31.
Purvin VA, Kawasaki A, Yee RD. Papilledema and obstructive sleep apnea syndrome. Arch Ophthalmol 2000; 118: 1626-30.
Stein JD, Kim DS, Mundy KM, et al. The association between glaucomatous and other causes of optic neuropathy and sleep apnea. Am J Ophthalmol 2011; 152: 989-98.
Abraham A, Peled N, Khlebtovsky A, et al. Nocturnal carbon dioxide monitoring in patients with idiopathic intracranial hypertension. Clin Neurol Neurosurg 2013; 115: 1379-81.
Javaheri S, Qureshi Z, Golnik K. Resolution of papilledema associated with OSA treatment. J Clin Sleep Med 2011; 7: 399-400.
Thurtell MJ, Bruce BB, Rye DB, et al. The Berlin questionnaire screens for obstructive sleep apnea in idiopathic intracranial hypertension. J Neuroophthalmol 2011; 31: 316-9.
Chasens ER, Pack AI, Maislin G, et al. Claustrophobia and adherence to CPAP treatment. West J Nurs Res 2005; 27: 307-21.
Pien GW, Rosen IM, Field BG. Sleep apnea syndromes: Central and obstructive. In: Senior R, Elias J, Fishman J, Grippi M, Senior R, Pack A, Editors. Fishman's pulmonary diseases and disorders. 5th ed. New York, NY: McGraw-Hill Education; 2015:1977-727.
Daroff RB, Fenichel GM, Jankovic J, et al. Bradley's Neurology in Clinical Practice: Neurological disorders. 6th ed. Philadelphia, PA: Elsevier/Saunders,2012; 1607.
Azagra-Calero E, Espinar-Escalona E, Barrera- Mora JM, et al. Obstructive sleep apnea syndrome (OSAS). Review of the literature. Med Oral Patol Oral Cir Bucal 2012; 17: e925-e929.
Kalyoussef E, Brooks NO, Quraishi H, et al. Idiopathic intracranial hypertension in a child with obstructive sleep apnea cured by tonsillectomy/adenoidectomy. J Neuroophthalmol 2013; 33: 413-4.
Derry CP, Duncan S. Sleep and epilepsy. Epilepsy Behav 2013; 26: 394-404.
Foldvary-Schaefer N, Andrews ND, Pornsriniyom D, et al. Sleep apnea and epilepsy: who's at risk? Epilepsy Behav 2012; 25: 363-7.
Ebersole JS, Pedley TA. Current Practice of Clinical Electroencephalography. Philadelphia, PA: Lippincott Williams & Wilkins, 2003: 349, 805.
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Issue | Vol 1 No 2 (2016): Spring | |
Section | Case Report(s) | |
Keywords | ||
Epilepsy Obstructive sleep apnea (OSA) Papiledema |
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