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Spindle coma is an electroclinical entity in which physiologic sleep patterns, such as sleep spindles in the 9 to 14 Hz range, vertex sharp waves, and K complexes, superimposed on a background of delta and theta activity, occur synchronously in patients with altered consciousness.1 Spindle coma has been associated with structural (traumatic and nontraumatic) and nonstructural causes,2 such as cerebrovascular disease, tumor, surgery, hypoxia, seizure, drug intoxication, metabolic disturbances, and vasovagal syncope.2,3 We report three cases of spindle coma secondary to limited paramedian midbrain infarction, in which the prognosis was favorable.
Case reports.
Patient 1.
A 35-year-old woman presented with decreased consciousness. At the emergency room, she was comatose, with decreased and shallow respiratory effort. She had Takayasu’s disease, diagnosed 15 years previously, and was in remission. Neurologic examination showed vertical gaze ophthalmoplegia, loss of pupillary reflexes, and preserved flexor responses to pain with motor power of Medical Research Council (MRC) grade 2/5. Brain MRI revealed an isolated right paramedian midbrain infarction with thrombosis at the distal …
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