Kleine-Levin syndrome and psychosis: Observation from an unusual case

Objective: This study evaluated the possible pathologic relation between Kleine-Levin syndrome (KLS) and mood disorders. Background: A 28-year-old man with a remote history of KLS had the sudden onset of a manic episode with psychotic features after the end of hypersomnolence. Method: The patient received an extensive laboratory examination, including single photon emission computed tomography and magnetic resonance imaging. Results: Single photon emission computed tomography showed decreased tracer perfusion in the basal ganglion, hypothalamus, and right frontotemporal region. Magnetic resonance imaging revealed a cystic lesion in the pineal region. Conclusions: Hypothalamic dysfunction has been described in KLS and mood disorders, but pineal gland dysfunction has been mentioned only rarely. The clinical and neuroimaging findings suggest the need for further study of KLS.