Narcolepsy following cerebral hypoxic ischemia.

A 51-year-old man with non-HLA-DR2 histocompatibility developed classic signs and symptoms of the narcoleptic tetrad soon after recovering from an episode of cardiopulmonary insufficiency, which occurred during induction of surgical anesthesia. Symptoms included excessive daytime sleepiness, hypnagogic hallucinations, sleep paralysis, and cataplexy. The diagnosis was confirmed by repeated polysomnographic examinations in the sleep laboratory. Cerebral hemodynamic changes during the onset of sleep showed remarkable increases of cerebral blood flow during the onset of rapid-eye-movement sleep similar to those reported previously in patients with narcolepsy. Magnetic resonance imaging showed focal regions of abnormal spin-echo signals in the ventral pons.