Correct!
5. Any of the above
A variety of pathological processes may result in FIRDA, it is a nonspecific finding. In particular, increased intracranial pressure of any cause, tumors, and systemic toxic and metabolic disorders including hyperglycemia, and renal and hepatic failure may be responsible (5). There is no association between FIRDA and seizures. Although the exact pathophysiological significance of FIRDA is uncertain, in otherwise normal individuals a search for underlying pathology should be undertaken (5).
Our patient had negative brain CT and MRI scans. She had no history of diabetes, hyperglycemia, renal disease or hepatic disease. Her daytime hypersomnolence is being managed with good sleep hygiene and strategic napping.
Final diagnosis: overnight polysomnography showing frontal intermittent rhythmic delta activity (FIRDA).
References
- Quan SF. Abuse of the Epworth Sleepiness Scale. J Clin Sleep Med. 2013 Oct 15;9(10):987. [CrossRef] [PubMed]
- Pogach M. Treating mild sleep apnea: Should you consider a CPAP device? Harvard Health Blog. June 15, 2020. Available at: https://www.health.harvard.edu/blog/treating-mild-sleep-apnea-should-you-consider-a-cpap-device-2020061520154 (accessed 12/5/22).
- Quan SF, O'Connor GT, Quan JS, et al. Association of physical activity with sleep-disordered breathing. Sleep Breath. 2007 Sep;11(3):149-57. [CrossRef] [PubMed]
- Wimms AJ, Kelly JL, Turnbull CD, et al. Continuous positive airway pressure versus standard care for the treatment of people with mild obstructive sleep apnoea (MERGE): a multicentre, randomised controlled trial. Lancet Respir Med. 2020 Apr;8(4):349-358. [CrossRef] [PubMed]
- Cobb W. Rhythmic slow discharges in the electroencephalogram. J Neurol Neurosurg Psychiatry. 1945;8:65-78. [CrossRef] [PubMed]
- Ryan CM, Murray BJ. An unexpected abnormality on the EEG. J Clin Sleep Med. 2010 Dec 15;6(6):613-5. [PubMed]