A 4-year-old boy has episodes in which, about 90 minutes after falling asleep, he suddenly sits up screaming, sweats, and appears terrified. His eyes are open but he does not respond to his parents, and the next morning he remembers nothing. Episodes occur only in the first third of the night. What is the most likely diagnosis?
- A Night terror (sleep terror) ✓
- B Nightmare disorder
- C Frontal lobe epilepsy
- D Confusional arousal with amnesia for events
Correct answer: A. Night terror (sleep terror)
Explanation
Night terrors arise from slow wave (stage N3) NREM sleep, hence their occurrence in the first third of the night, with partial arousal, autonomic discharge, unresponsiveness during the event, and complete amnesia afterward. The single fact that kills the nightmare option is timing and recall: nightmares occur in REM sleep in the latter part of the night and leave vivid, detailed recall. Management is parental reassurance, since the condition is benign and self-limiting.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.