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A 25-year-old man presents to the outpatient clinic complaining of feeling sleepy all the time, even during the daytime. The symptoms have persisted for years and are now brought to medical attention after falling asleep at work on multiple occasions. He is concerned that he might lose his job. He has no past medical history and is not taking any sedative medications. On physical examination, he is slender and the heart and lung exams are normal. Neurologic assessment reveals normal orientation, memory, concentration, and no focal deficits. Which of the following symptoms might he also complain about?

Question Category:
Correct Answer:
automatic behavior (wife's report)
Description:
The early age of onset and otherwise good health suggest a diagnosis of narcolepsy, which is usually accompanied by other symptomatology. Hypnagogic hallucinations are almost always visual. They occur most frequently at the onset of sleep, either during the day or at night. They are generally very vivid. Cataplexy is a brief loss of muscle power without loss of consciousness. The patient is fully aware of what is going on. The paralysis may be complete or partial. Automatic behavior with amnesia is a common manifestation of the narcolepsy cataplexy syndromes, occurring in 50% of cases. Automatic behavior can be confused with complex partial seizures. Paresthesia are not part of narcolepsy syndrome. Snoring, restless sleep, and morning headache suggest sleep apnea.
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