Clinical Vignettes: Illustrative, Unusual, and Challenging RBD Cases

REM sleep behavior disorder (RBD) can be a clinical conundrum representing a diagnostic challenge for clinicians who are not familiar with it. This chapter highlights the diverse clinical presentations that often predispose the emergence of dream enactment behaviors in neurologic conditions. Cases will be discussed where RBD emerged in the setting of autoimmune limbic encephalitis in the vicinity of the rostral pons and in the setting of hypocretin (orexin) deficiency syndrome due to neurosarcoidosis of the diencephalon. Discussion will also review the challenge of disclosure of the diagnosis of RBD and disclosure of the prognostic implications of RBD as it relates to the implications of neurodegeneration later in life. Finally, a case of a young woman on antidepressants will be provided, covering newly emerging data implicating this class of medications in dream enactment behaviors and REM sleep without atonia.