A discrete pontine ischemic lesion could cause REM sleep behavior disorder

REM sleep behavior disorder (RBD) is characterized by lack of atonia of major muscle groups during REM sleep associated with excessive movement related to dreaming.1 Various neurodegenerative diseases involving brainstem structures have been reported to be associated with RBD.2 We report a patient with RBD with the sole lesion in the pontine reticular formation that could cause the abnormality of REM-mediated muscle atonia. A 75-year-old woman was admitted to our hospital complaining of frequent episodes of transient dizziness and abnormal nocturnal behavior. This behavior started about 10 years before, when she also had a TIA manifesting as transient weakness in the right upper and lower extremities. She had a 9-year history of diabetes mellitus and hypertension, both of which were well controlled on diet and exercise therapy. Her nocturnal behavior was characterized by waving her arms, beating herself at the wall, and kicking the bedclothes. During these episodes, she often shouted because she became angry with employees of her company in her …