The investigations included a magnetic resonance image and a magnetic resonance angiogram of the brain, which did not show any new vascular events. His neurological exam suggested a right temporal homonymous hemianopsia from his previous stroke, but the rest of the results was within normal limits. His body mass index was 30 with a Mallampati score of 1, and his general physical examination was unremarkable. On physical exam, he was afebrile and normotensive without tachypnea.

The patient's past medical history was significant for hypertension, hypercholesteremia, long-standing type 2 diabetes mellitus, and a hemorrhagic stroke 3 years ago with secondary mild cognitive impairment, but fortunately without physical impairment. His family history was non-contributory except for hypertension and diabetes. He denied any other history of regular headaches, migraines, or cluster headaches in the past. He attributed his fatigue to stress at work and the fact that he had to make greater effort to finish his daily tasks. He generally woke up feeling refreshed, but as the day progressed he became more tired but not sleepy. He was known to snore, but there was no evidence of any witnessed apneas or snorting. He denied any difficulty in falling asleep or any disturbance in the legs to suggest restless leg syndrome. His other neurological complaints included mild forgetfulness and increased tiredness and fatigue, mostly towards the end of the day. These episodes were not associated with any autonomic symptoms, focal weakness, visual or speech disturbances, seizures, postictal confusion, or incontinence. All four episodes had identical symptoms and he was in the supine position sleeping in his bed at night when the events occurred. Once awakened, he did not feel any pain or headaches.

He was able to pinpoint the moment when the symptoms started during the night. The patient stated that all episodes occurred in the early part of his sleep and that these flashing sounds awaken him with a sudden electric jolt-like sound in the right side of his head. He described these events ‘as if there are explosions in my head’. A 57-year-old, right-handed Indian male presented for evaluation of four separate episodes of awakening after hearing a flashing sound on the right side of his head over the last 2 years.

Spacechem exploding head syndrome