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Peer-reviewedCC BY-NC-NDBMC neurology

Excessive daytime sleepiness caused by multiple focal strokes in thalamus, hypothalamus, and Edinger-Westphal nucleus: a case report.

  • Yanan Zhang1,2
  • Ruiqi Wang1,2
  • Qingqing Sun1,2
  • Lijia Cai1,2
  • Jun Lu1,2
  • Zan Wang3,4
4 affiliations
  1. 1Sleep Center, Department of Neurology, the First Hospital of Jilin University, Changchun, China.
  2. 2Stroke Center, Department of Neurology, the First Hospital of Jilin University, Changchun, China.
  3. 3Sleep Center, Department of Neurology, the First Hospital of Jilin University, Changchun, China. [email protected].
  4. 4Stroke Center, Department of Neurology, the First Hospital of Jilin University, Changchun, China. [email protected].
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Abstract

Background

Sleep and wakefulness regulation is mediated by distributed interactions among thalamocortical circuits, hypothalamic orexinergic systems, and brainstem modulatory networks. Although the Edinger-Westphal nucleus is traditionally associated with parasympathetic pupillary control, its potential contribution to sleep and wakefulness regulation remains incompletely understood.Case presentation

We report a case of a 58-year-old male patient with excessive daytime sleepiness, bilateral ptosis with mydriasis (pupil diameter 6.0 mm), and complete loss of both direct and consensual light reflexes. The symptoms of hypersomnia disappeared and 24-hour polysomnography result was partially improved, with exception of still absence of stage 3 non-rapid eye movement sleep one month later. There was no improvement in the symptoms of oculomotor nerve paralysis and mydriasis.Conclusion

Thalamic and hypothalamic lesions can produce severe but partially reversible hypersomnia, likely mediated through disruption of thalamocortical and orexinergic systems. Midbrain involvement results in persistent oculomotor dysfunction. This case highlights the importance of distributed network interactions in sleep and wakefulness regulation and should be interpreted cautiously with regard to the specific role of the Edinger-Westphal nucleus.

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Cite

BibTeXRIS
BibTeX
@article{zhang2026excessive,
  title = {{Excessive daytime sleepiness caused by multiple focal strokes in thalamus, hypothalamus, and Edinger-Westphal nucleus: a case report.}},
  author = {Yanan Zhang and Ruiqi Wang and Qingqing Sun and Lijia Cai and Jun Lu and Zan Wang},
  journal = {BMC neurology},
  year = {2026},
  month = aug,
  doi = {10.1186/s12883-026-05243-3},
  url = {https://europepmc.org/article/MED/42972297},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Excessive daytime sleepiness caused by multiple focal strokes in thalamus, hypothalamus, and Edinger-Westphal nucleus: a case report.
AU  - Yanan Zhang
AU  - Ruiqi Wang
AU  - Qingqing Sun
AU  - Lijia Cai
AU  - Jun Lu
AU  - Zan Wang
PY  - 2026
DA  - 2026/08/06
JO  - BMC neurology
DO  - 10.1186/s12883-026-05243-3
UR  - https://europepmc.org/article/MED/42972297
AB  - Background  Sleep and wakefulness regulation is mediated by distributed interactions among thalamocortical circuits, hypothalamic orexinergic systems, and brainstem modulatory networks. Although the Edinger-Westphal nucleus is traditionally associated with parasympathetic pupillary control, its potential contribution to sleep and wakefulness regulation remains incompletely understood.Case presentation  We report a case of a 58-year-old male patient with excessive daytime sleepiness, bilateral ptosis with mydriasis (pupil diameter 6.0 mm), and complete loss of both direct and consensual light reflexes. The symptoms of hypersomnia disappeared and 24-hour polysomnography result was partially improved, with exception of still absence of stage 3 non-rapid eye movement sleep one month later. There was no improvement in the symptoms of oculomotor nerve paralysis and mydriasis.Conclusion  Thalamic and hypothalamic lesions can produce severe but partially reversible hypersomnia, likely mediated through disruption of thalamocortical and orexinergic systems. Midbrain involvement results in persistent oculomotor dysfunction. This case highlights the importance of distributed network interactions in sleep and wakefulness regulation and should be interpreted cautiously with regard to the specific role of the Edinger-Westphal nucleus.
SN  - 1471-2377
ER  -