Somnolence: Causes & Reasons

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Possible Causes for Somnolence

Cinchonism

Large doses of quinine may lead to severe (but reversible) symptoms of cinchonism: skin rashes, deafness, somnolence, diminished visual acuity or blindness, anaphylactic shock [en.wikipedia.org]

Large doses of quinine may lead to severe symptoms of cinchonism: skin rashes, deafness, somnolence, diminished visual acuity or blindness, anaphylactic shock, and disturbances [academickids.com]

Hepatic Encephalopathy

Clinically overt HE includes personality changes, alterations in consciousness progressive disorientation in time and space, somnolence, stupor and, finally, coma. [ncbi.nlm.nih.gov]

[…] addition Grade 2 Lethargy or apathy Minimal disorientation for time or place Subtle personality change Inappropriate behavior Impaired performance of subtraction Grade 3 Somnolence [aafp.org]

Back to the Case Our patient has severe HE manifested by worsening somnolence. [the-hospitalist.org]

Obstructive Sleep Apnea

Neither patient exhibited daytime somnolence, although both were subsequently found to have severe obstructive sleep apnea. [ncbi.nlm.nih.gov]

A 55-year-old woman who presented to the sleep clinic with severe sleep apnea (OSA) (apnea-hypopnea index [AHI] 62) and excessive somnolence (Epworth Sleepiness Scale score [ncbi.nlm.nih.gov]

Multilevel TCRFTA treatment of mild to moderate OSAS resulted in prolonged improvement in daytime somnolence, OSAS-related quality of life, psychomotor vigilance, and AHI [ncbi.nlm.nih.gov]

Kleine-Levin Syndrome

Levin M: Periodic somnolence and morbid hunger: a new syndrome. Brain 1936;59:494–504. [doi.org]

KLS should be considered in young patients, who present with episodes of undue somnolence. [ncbi.nlm.nih.gov]

Critchley M, Hoffman H: The syndrome of periodic somnolence and morbid hunger (Kleine–Levin syndrome). BMJ 1942;1:137–139. [doi.org]

Nocturnal Myoclonus Syndrome

Its most common adverse effects include somnolence and dizziness. It is less likely to cause augmentation than the dopaminergic drugs. [msdmanuals.com]

Its most common adverse effects include somnolence and dizziness. [merckmanuals.com]

Dizziness and somnolence are the most common adverse effects. However, use of this drug to treat RLS has not been extensively studied. [msdmanuals.com]

Narcolepsy

A condition characterized by recurrent episodes of daytime somnolence and lapses in consciousness (microsomnias) that may be associated with automatic behaviors and amnesia [icd9data.com]

Narcolepsy is characterized by excessive daytime somnolence associated with sleep paralysis, hallucinations when falling asleep or awakening, and cataplexy. [ncbi.nlm.nih.gov]

She currently has severe somnolence, obesity, and partial cataplectic attacks along with normal mood, academic failure and social isolation. [ncbi.nlm.nih.gov]

Juvenile Myxedema

[…] levothyroxine High mortality rate Myxedema coma almost always occurs in the elderly non compliance with hypothyroid treatment *Extreme hypothermia: 75.2-90°F (24-32.2°C) *Somnolence [quizlet.com]

Hyperthyroidism. hy·po·thy·roid·ism ( hī'pō-thī'royd-izm ) Diminished production of thyroid hormone, leading to clinical manifestations of thyroid insufficiency, including somnolence [medical-dictionary.thefreedictionary.com]

Symptoms Feeding difficulties Somnolence Lethargy Low frequency of crying Constipation Signs Large fontanelles Myxoedema - with coarse features and a large head and oedema [patient.info]

West African Trypanosomiasis

A 67-year-old Caucasian man presented with a 10-month history of cognitive deterioration, ataxic gait, somnolence and urinary incontinence. [ncbi.nlm.nih.gov]

Gradually over a period of months, neurological symptoms begin to manifest. 80% become somnolent. Five to ten per cent have behavioural changes or psychosis. [ncbi.nlm.nih.gov]

Somnolence is the classic symptom of the disease; however it is preceded by a period of nighttime insomnia and daytime somnolence. [dermnetnz.org]

African Trypanosomiasis

A 67-year-old Caucasian man presented with a 10-month history of cognitive deterioration, ataxic gait, somnolence and urinary incontinence. [ncbi.nlm.nih.gov]

Somnolence is the classic symptom of the disease; however it is preceded by a period of nighttime insomnia and daytime somnolence. [dermnetnz.org]

The encephalopathy leads to apathy, somnolence and coma. Death is usually caused by intercurrent infections such as pneumonia. [dna.kdna.ucla.edu]

Sleep Apnea

In epilepsy patients with risk factors (eg, obesity) or markers (eg, habitual snoring, daytime somnolence) for sleep apnea, a careful sleep history should be elicited and [ncbi.nlm.nih.gov]

[…] although clinical reports of SDB were first made in the 19th century. 1 Likely influenced by such observations, descriptions of an entity constituting obesity and extreme somnolence [accessmedicine.mhmedical.com]

During last year, the patient was accusing excessive daytime somnolence, breath arrests during sleep, intense snoring, morning headaches, morning oral dryness, pin point chest [ncbi.nlm.nih.gov]

Western Equine Encephalomyelitis

2 and 6 days), then general depression, dullness, anorexia, stiffness, ataxia, hyperesthesia, aggression, excitability, continuous chewing movements, aimless wandering, somnolence [vetstream.com]

[…] rare cases, WEEV infection may cause encephalitis or encephalomyelitis, resulting in neck stiffness, confusion, visual disturbances, photophobia, tonic-clonic seizures, somnolence [msdsonline.com]

The initial clinical signs of EEE in affected horses caninclude any of the following: biphasic fever, anorexia, somnolence, head pressing, stiff neck, and proprio-ceptive [addl.purdue.edu]

Ornithine Transcarbamylase Deficiency

A 22-year-old woman with a negative urine drug screen and somnolence rapidly reversed by intravenous flumazenil was found to have elevated ammonia levels and punctate calcifications [ncbi.nlm.nih.gov]

Clinical description Males with the severe, neonatal-onset type are normal at birth but develop poor sucking, hypotonia and lethargy after a few days, rapidly progressing into somnolence [orpha.net]

Although computed tomography findings are non-specific, young patients with unexplained hyperammonemic states of somnolence reversed by flumazenil should be screened for this [ncbi.nlm.nih.gov]

Hyperammonemia Type 3

Patients We describe 2 patients with type II citrullinemia who presented with episodic postprandial somnolence and coma. [jamanetwork.com]

The pathophysiology of hyperammonemia is that of a CNS toxin that causes irritability, somnolence, vomiting, cerebral edema, and coma that leads to death. [emedicine.medscape.com]

VPA dosage to 1,500 mg/day, her elated mood and grandiosity were gradually improved, but she started to develop confusion, disorganized behaviors, and aggravated daytime somnolence [e-tjp.org]

Restless Legs Syndrome

Placebo comparisons showed a significantly higher incidence of nausea for pramipexole (p<0.01), whereas nausea, vomiting, dizziness, and somnolence were significantly higher [ncbi.nlm.nih.gov]

The main side effects were dizziness, somnolence, headache, and irritability. [ncbi.nlm.nih.gov]

Its most common adverse effects include somnolence and dizziness. [merckmanuals.com]

Citrullinemia Type 2

[…] common denominator, hyperammnemia, can manifest clinically as some or all of the following: Anorexia Irritability Heavy or rapid breathing Lethargy Vomiting Disorientation Somnolence [checkorphan.org]

Patients We describe 2 patients with type II citrullinemia who presented with episodic postprandial somnolence and coma. [jamanetwork.com]

Clinical signs of the milder form include recurrent lethargy, somnolence, mental retardation, and chronic or recurrent hyperammonemia. [preventiongenetics.com]

Sepsis-Associated Encephalopathy

"The first manifestation of SAE is an acute change in mental status, ranging from inattention, disorientation, agitation, somnolence, stupor and coma," the authors write. [news-medical.net]

[…] subtraction Grade II Lethargy or apathy, minimal disorientation for time or place, subtle personality change, inappropriate behavior, asterixis usually present Grade III Somnolence [clinicaladvisor.com]

Acute Hepatic Porphyria

That’s called somnolence. In serious cases, you could go into a coma. Insomnia. That means you’ll have trouble falling or staying asleep. Low levels of electrolytes. [webmd.com]

[…] psychological symptoms including irritability, depression, anxiety, insomnia, hallucinations, paranoia, disorientation, and altered consciousness ranging from excessive drowsiness (somnolence [rarediseases.org]

Carbamoyl Phosphate Synthetase Deficiency

Children may become lethargic, somnolent and fall into coma. Seizures are common. [symptoma.com]

Symptoms include the following: Anorexia Irritability Heavy or rapid breathing Lethargy Vomiting Disorientation Somnolence Asterixis (rare) Combativeness Obtundation Coma [emedicine.medscape.com]

Symptoms appear as feeding is established and can include feeding difficulties, vomiting, somnolence, hypotonia, hypothermia, seizure, coma, and apnoea; rapid progression [journals.lww.com]

Viral Encephalitis

Clinical manifestations include CONFUSION, somnolence, FEVER, nuchal rigidity, and involuntary movements. The illness may progress to COMA and eventually be fatal. [bioportfolio.com]

Epidural Hematoma

The exam may also show signs of increased ICP, such as: Headaches Somnolence Confusion Nausea and vomiting If there is increased ICP, emergency surgery may be needed to relieve [nlm.nih.gov]

[…] can result in clinically significant morbidity and/or mortality if it is not diagnosed and treated promptly. [1, 2] EDH is considered a neurosurgical emergency in which somnolence [emedicine.medscape.com]

Eastern Equine Encephalitis

This is followed by the emergence of neurological features, such as confusion, focal neurological signs, generalized or focal seizures, meningism, and somnolence 1. [radiopaedia.org]

Highlands J and EEE infections can also cause depression, somnolence, decreased egg production and increased mortality in turkeys. [nj.gov]

Somnolence, confusion, cranial nerve palsy, abdominal pain and diarrhea, and autonomic disturbances like sialorrhoea are common. [symptoma.com]

Myxedema

Signs and symptoms of hypothyroidism include low metabolic rate, tendency to weight gain, somnolence and sometimes myxedema. [icd9data.com]

Usually somnolence and lethargy have been present for months. Lethargy may develop via stupor into a comatose state. [ncbi.nlm.nih.gov]

Meningeal Tuberculosis

Headache and meningeal irritation may be followed by SEIZURES, cranial neuropathies, focal neurologic deficits, somnolence, and eventually COMA. [connects.catalyst.harvard.edu]

Central Sleep Apnea

Patients with hypercapnic forms may experience daytime somnolence (sometimes called wake-time sleepiness), lethargy, and morning headache. [merckmanuals.com]

Gastaut and his collaborators in their report on the abnormal breathing patterns observed in a subtype of so-called "Pickwickian patients," morbidly obese subjects with somnolence [medlink.com]

Morbidly obese with right heart failure and somnolence - Those on chronic opioids or with neuromuscular disease - Chronic heart failure and low EF -Refer to sleep specialist [quizlet.com]

Acute Alcohol Intoxication

Somnolence, stupor, disorientation and disturbance of balance are common and well recognized symptoms of the depression of the central nervous system (CNS) related to alcohol [academic.oup.com]

Patients are generally calm and somnolent," said Blatman. "Let them stay that way by avoiding arguments or provocation." [ems1.com]

Consciousness was assessed on a scale from normal (1 point) to severely aggravated (4 points): clear consciousness, disorientation, somnolence, stupor or coma (estimated on [academic.oup.com]

Toxic Encephalopathy

After a cumulative dose of 240 mg/m(2) the patient suddenly became somnolent and developed a severe tetraparesis and generalized seizures. [ncbi.nlm.nih.gov]

[…] attributed his symptoms to job stress, he began experiencing extreme fatigue, diminished energy, lack of concentration, body aches, chills, mood swings, confusion, increased somnolence [experttoxicologist.com]

He was somnolent but reactive without focal neurological signs; the Glasgow Coma Scale (GCS) was 13 and he had isochoric and photoreactive pupils. [scielo.mec.pt]

Postictal State

Excessive daytime somnolence - eg, due to a sleep apnoea or narcolepsy. Periodic limb movement disorder. Tardive dyskinesia. Panic attacks. [patient.info]

Postictal patients may also be confused or combative, especially as they transition from somnolent to awake. [ems1.com]

somnolent? if so, for how long?). Physical Examination Vital signs and blood sugar should be obtained immediately on all patients. [unboundmedicine.com]

West Nile Encephalitis

[…] fasciculation; hyperesthesia (hypersensitivity to touch and sound); changes in mentation (mentality), when horses look like they are daydreaming or “just not with it”; occasional somnolence [thehorse.com]

On presentation, the patient was somnolent but arousable. [hindawi.com]

[…] front end, or both, characterized by falling to their knees or difficulty in remaining standing), ataxia (incoordination), muscle twitching or tremors, altered mental state (somnolent [ento.psu.edu]

Leukostasis

Neurological signs - visual changes, headache, dizziness, tinnitus, gait instability, confusion, somnolence, coma. [en.wikipedia.org]

Extrapulmonary signs and symptoms in the central nervous system can range from headache to mild confusion to somnolence to coma. [pulmonarychronicles.com]

Table 1 Symptoms of leukostasis Organ Symptoms Lung dyspnea, hypoxemia, diffuse alveolar hemorrhage, respiratory failure Central nervous system confusion, somnolence, dizziness [ncbi.nlm.nih.gov]

Hypoglycemia

Hypoglycemia manifests with autonomic symptoms (i.e., hunger, sweating, tachycardia) and neuroglycopenic symptoms (i.e., confusion, behavioral changes, somnolence). [amboss.com]

[…] coma)(E10-E14의 4단위숫자 .0) 간성 혼수(hepatic coma)(K72.-) 저혈당성(비당뇨성) 혼수(hypoglycaemic (nondiabetic) coma)(E15) 신생아 혼수(neonatal coma)(P91.5) 요독증성 혼수(uraemic coma)(N19) R40.0 최면(Somnolence [dic.impact.pe.kr]

Nocturnal attacks are often preceded by nightmares and cause severe sleep disturbance resulting in daytime somnolence. Only a perfect diet will control hypoglycemia. [fibromyalgiatreatment.com]