Abstract

We found a rare case of Kleine-Levin syndrome in an adolescent female with decreased intracranial pressure. The patient developed symptoms of decreased appetite, depression and anhedonia. The clinical symptoms were similar to an affective disorder of depression attack since the patient had periodic symptoms of excessive sleep and gluttony, accompanied by an involuntary special "Crouching phenomenon" involving hip and knee flexion while holding her legs tightly and lying on her knees. She was not considered narcoleptic after polysomnography and multiple sleep latency tests. Finally, a lumbar puncture revealed low intracranial pressure (65mmH2O). Hypothalamic orexin-A detected in the cerebrospinal fluid was at the lower normal limit. After symptomatic treatment involving fluid infusion and increasing intracranial perfusion pressure, the patient's periodic symptoms and social functioning improved with reduced instances of the special "Crouching phenomenon."