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Case Reports
. 2014 Sep 15;10(9):1037-8.
doi: 10.5664/jcsm.4028.

Restless legs syndrome as a first manifestation of a cerebral infarct

Elisabeth Ruppert, Ulker Kilic-Huck, Valérie Wolff, Laurent Tatu, Marion Ghobadi, Marc Bataillard, Patrice Bourgin
Case Reports

Restless legs syndrome as a first manifestation of a cerebral infarct

Elisabeth Ruppert et al. J Clin Sleep Med. .

Abstract

The onset of restless legs syndrome (RLS) is usually progressive and the neural substrates underlying its pathophysiology remain to be identified. Here we report on a patient presenting with acute-onset RLS that was symptomatic of a right anteromedial pontine infarction. This case is exceptional because RLS appeared several hours before the occurrence of a regressive dysarthria clumsy-hand syndrome. Additionally, millimetric MRI sections showed that the structures possibly involved in RLS pathogenesis were the corticospinal tract, the pontine nuclei, and the pontocerebellar fibers. Although this is uncommon, clinicians should be aware that RLS characterized by a sudden onset can be a clinical manifestation related to stroke.

Keywords: RLS; RLS pathophysiology; periodic limb movements; pontine anteromedial infarction; pontine stroke; restless legs syndrome.

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Figures

Figure 1
Figure 1
(A) Infarction of the ventral part of the pontine anteromedial territory on T1 MRI sequence lateral section (arrow). (B) Section of the middle part of the pons. (1) Corticospinal tract split into small fasciculi (2) Pontocerebellar fibers (3) Pontine nuclei (4) Medial lemniscus. AMv, Anteromedial pontine arterial territory (ventral part); AMd, Anteromedial pontine arterial territory (dorsal part); AL, Anterolateral pontine arterial territory; Lv, Lateral pontine arterial territory (ventral part); Ld, Lateral pontine arterial territory.
See this image and copyright information in PMC

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