Fait cliniqueSomnambulisme avec mise en danger vital (syndrome d'Elpénor) chez un enfantLife-threatening sleepwalking (Elpenor's syndrome) in a 10-year-old child

RésuméIntroductionBien que généralement bénin, le somnambulisme peut causer des accidents dus, entre autres, à des chutes. Ces accidents peuvent parfois comporter une mise en danger vital - situation dénommée « syndrome d'Elpénor » (en référence à un accident survenant à un personnage de L'odyssée d'Homère) - en particulier par défenestration. Ce syndrome a été décrit chez l'adulte et l'adolescent ; nous relatons un cas chez une enfant.ObservationCette enfant de 10 ans a été admise au service d'accueil des urgences en pleine nuit suite à une chute du premier étage de son domicile, compliquée de fractures. La défenestration était survenue aux alentours de 1 h. L'enfant s'était endormie à 23 h, dans des conditions inhabituelles de couchage et dans un contexte de dette de sommeil. L'examen clinique réalisé au décours des soins d'urgence n'a montré aucun signe de trouble mental ni d'idéation suicidaire, ni aucune autre anomalie clinique ; l'enfant présentait une amnésie de l'accident. Il existait des antécédents personnels et familiaux de somnambulisme. Le diagnostic d'un épisode de somnambulisme avec une mise en danger vital a été porté ; l'enfant et ses parents ont bénéficié d'une éducation thérapeutique et une sécurisation de l'environnement nocturne a été prescrite. Il n'a pas été instauré de traitement pharmacologique. Au cours des 18 mois suivants, un seul épisode somnambulique a été observé, sans comportement à risque.Conclusionle syndrome d'Elpénor existe chez l'enfant, il est donc important d'informer l'entourage d'un enfant somnambule de la nécessité de toujours sécuriser l'environnement nocturne.

SummaryThough benign in the majority of cases, sleepwalking sometimes causes injuries due, among other causes, to falls. Such accidents can be life-threatening - a situation that has been termed Elpenor syndrome (in reference to an accident experienced by a character in Homer's epic The Odyssey) - in particular when entailing defenestration. This syndrome has been described in adults and adolescents; we report here a case in a child.ObservationThis 10-year-old girl was admitted at night to our hospital after a 3-m fall at home. She was alert (Glasgow score, 15) at admission; a frontal wound and a deformation of the right wrist were noted. Brain CT scans showed a frontal skull fracture and frontal lobe contusion, wrist x-rays showed a displaced right fracture. The patient underwent urgent neurosurgery (wound excision and suture after reduction of skull fracture) and closed reduction and immobilization of the wrist fracture, both under general anesthesia. She underwent a psychiatric assessment in the intensive care unit 3 days after her fall. She was alert, well-oriented in time and space, and spoke fluently. She had no memory of her fall, only remembering going to bed in the evening before the accident and waking up in the ambulance on the way to the hospital. She displayed no sign of a concurrent mental illness and no suicidal ideas. Her parents reported that the evening of the accident she and her two brothers had all fallen asleep about 11:00 pm while watching TV, in the double bed of the guest room, placed just beside its window. At approximately 1:00 am, her father, who was going to bed and had just made noise in the hall, heard a cry from the guest room. He entered the room immediately and saw the opened window and his daughter lying on the outside ground; the brothers only awakened after the fall. The family had returned 2 days before from a 6-month stay in the United States, with jet-lag, sleep deprivation, and a disorganized sleep/wake rhythm in the patient. There was no medication before the accident, no substance use (including caffeine), and no concurrent medical problem. Over the 2 preceding years, the patient had undergone two witnessed episodes of early-nighttime arousal with altered consciousness and calm wandering (including going downstairs on one occasion), both strongly suggesting sleepwalking. There was a history of sleepwalking in her father and her older brother. Life-threatening sleepwalking (Elpenor syndrome) was diagnosed. The child and her parents were educated about sleepwalking; regularization of sleep schedules and sleep extension (avoidance of sleep deprivation, short napping when possible) were prescribed. We also recommended securing the home (bed, windows, and stairways). No pharmacological treatment was instituted. During the following 18 months, the child manifested only one noted sleepwalking episode, without risk-taking. She had no neurological or psychopathological sequela from her accident, of which she never had a memory.ConclusionElpenor syndrome can occur in a child; consequently, it is important to inform parents of children with sleepwalking about the necessity of always securing the night-time environment.