A 38-year-old mother of two presents due to screaming and thrashing during her sleep. She's not under any exceptional stress and has a history of chronic allergies. Do you know what's wrong?
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, pleaseA 38-year-old woman presents to her primary care physician with a complaint of bad dreams.
The patient says that her husband has recently noticed that she has been screaming and thrashing her arms about during her sleep on some nights. When he has told her about these episodes in the morning, she has thought that they occur on the same nights that she has the bad dreams. Overall, she describes herself as well rested and says that she does not consume any caffeinated beverages before sleeping. She has not had any significant change in her sleep habits, and she denies any physical discomfort or change in the temperature or lighting in the room when she sleeps.
She says that she is not under exceptional stress but remarks that she feels under more pressure than usual because of managing her household with two children in grade school, as well as working full-time as an administrative assistant at a local business. She often feels rushed and arrives at work late after getting her children on the school bus. Sometimes she needs to finish work at home that she did not complete during her workday.
Lately, her symptoms have worsened, and she has been taking medication that she removed from its original packaging and placed in a sandwich bag so that it could fit in her purse. She does not recall the name of the medication but says that she usually buys whichever decongestant is on sale at the store.
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