1337 Polytrauma Medicine Consult Due to Nocturnal Fall: A Case of REM Sleep Behavior Disorder

Abstract Introduction Falls are the leading cause of fatal and nonfatal injuries among adults ages 65 years and older, with 1 in 4 older adults reporting a fall every year. REM Sleep Behavior Disorder (RBD), characterized by dream enactment during REM sleep, can precede neurodegenerative diseases such as Parkinson’s disease (PD). This case highlights the importance of thorough fall assessments in uncovering early signs of neurodegenerative pathology. Report of case(s) A 73-year-old male with a history of hypertension presented to Providence Everett Medical Center as a polytrauma patient following a nocturnal fall. He sustained four rib fractures and required one day of intensive care monitoring. In accordance with institutional policy, a medicine consultation was initiated to evaluate for underlying medical contributors to the fall. The initial fall was recorded as mechanical fall. Detailed history revealed a two-year pattern of dream enactment behaviors, including shouting and flailing during sleep, previously unreported to medical providers. His presenting fall was due to a vivid dream of a gorilla chasing him, during which he ran into his dresser while still sleeping, striking it and falling to the ground. No new medications or supplements were reported; he only takes amlodipine for HTN. Laboratory studies were normal. Imaging revealed left 4-7 rib fractures. He was found to have cogwheel rigidity and bradykinesia in left upper extremity. Family history notable for sister with PD diagnosed at age 75. The patient was started on melatonin, resulting in partial improvement of RBD symptoms. He was advised to follow up with his primary care provider for further titration and neurology. At his neurology appointment, he was formally diagnosed with Parkinson’s disease. Conclusion This case underscores the diagnostic value of a comprehensive fall history in older adults, detailed neurologic examination, and ruling out alternative causes of falls. RBD may be an early manifestation of synucleinopathies such as PD, often preceding motor symptoms by years. Early recognition can prompt timely neurological referral, safety interventions, and symptom management. Support (if any)