Restless legs syndrome secondary to pontine infarction: Clinical analysis of five cases
Objective: Pontine infarction is a common type of stroke in the cerebral deep structures, resulting from occlusion of small penetrating arteries, may manifest as hemi-paralysis, hemi-sensory deficit, ataxia, vertigo, and bulbar dysfunction, but patients presenting with restless legs syndrome (RLS) a...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2017-09-01
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| Series: | Chronic Diseases and Translational Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2095882X17300609 |
| _version_ | 1811228003998367744 |
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| author | Hou-Zhen Tuo Ze-Long Tian Yi-Nong Cui Xiao-Yang Ma Chun-Ling Xu Hong-Yan Bi Li-Yan Zhang Yong-Bo Zhang Wei-Dong Le William Ondo |
| author_facet | Hou-Zhen Tuo Ze-Long Tian Yi-Nong Cui Xiao-Yang Ma Chun-Ling Xu Hong-Yan Bi Li-Yan Zhang Yong-Bo Zhang Wei-Dong Le William Ondo |
| author_sort | Hou-Zhen Tuo |
| collection | DOAJ |
| description | Objective: Pontine infarction is a common type of stroke in the cerebral deep structures, resulting from occlusion of small penetrating arteries, may manifest as hemi-paralysis, hemi-sensory deficit, ataxia, vertigo, and bulbar dysfunction, but patients presenting with restless legs syndrome (RLS) are extremely rare. Herein, we reported five cases with RLS as a major manifestation of pontine infarction. Methods: Five cases of pontine infarction related RLS were collected from July 2013 to February 2016. The diagnosis of RLS was made according to criteria established by the International RLS Study Group (IRLSSG) in 2003. Neurological functions were assessed according to the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Severity of RLS was based on the International RLS Rating Scale (IRLS-RS). Sleep quality was assessed by Epworth Rating Scale (ERS), and individual emotional and psychological states were assessed by Hamilton Depression Scale (HDS) and Hamilton Anxiety Scale (HAS). Results: The laboratory data at the onset including hemoglobin, serum concentration of homocysteine, blood urea nitrogen (BUN), creatinine, electrolytes, and thyroid hormones were normal. The electroencephalogram (EEG), lower-extremity somatosensory evoked potential (SEP), and nerve conduction velocity (NCV) in four limbs were normal. The average period of follow-up was 34.60 ± 12.76 months. The MRI examination showed acute or subacute pontine infarction lesions, 3 cases in the rostral inner side, 1 case in the rostral lateral and inner side, and 1 case in rostral lateral side. The neurological deficits included weakness in 4 cases, contralateral sensory deficit in 1 case, and ataxia in 2 cases. All 5 patients presented with symptom of RLS at or soon after the onset of infarction and 4 patients experienced uncomfortable sensations in the paralyzed limbs contralateral to the ischemic lesion. Their neurological deficits improved significantly 2 weeks later, but the symptoms of RLS did not resolve. Among them, 3/5 patients were treated with dopaminergic drugs. At the end of the follow-up, RLS symptom eventually resolved in 3 patients but persisted in two. The IRLS-RS, NIHSS and mRS scores were significantly lower at the onset than those at the last follow-up (P = 0.035, 0.024 and 0.049, respectively). However, there was no significant difference in the ERS, HDS and HAS scores (P = 0.477, 0.226 and 0.778, respectively). Conclusion: RLS can be an onset manifestation of pontine infarction, clinicians should be aware of this potential symptom. RLS usually occurs in the paralyzed limbs contralateral to the infarction lesion. The pathogenesis still needs further investigation. Keywords: Restless legs syndrome, Pontine infarction, Clinical features |
| first_indexed | 2024-04-12T09:51:12Z |
| format | Article |
| id | doaj.art-9b7c5e037cbb41b09a8a1f273b1da1a9 |
| institution | Directory Open Access Journal |
| issn | 2095-882X |
| language | English |
| last_indexed | 2024-04-12T09:51:12Z |
| publishDate | 2017-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Chronic Diseases and Translational Medicine |
| spelling | doaj.art-9b7c5e037cbb41b09a8a1f273b1da1a92022-12-22T03:37:49ZengWileyChronic Diseases and Translational Medicine2095-882X2017-09-0133186190Restless legs syndrome secondary to pontine infarction: Clinical analysis of five casesHou-Zhen Tuo0Ze-Long Tian1Yi-Nong Cui2Xiao-Yang Ma3Chun-Ling Xu4Hong-Yan Bi5Li-Yan Zhang6Yong-Bo Zhang7Wei-Dong Le8William Ondo9Department of Neurology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing 100050, China; Corresponding author.Department of Neurology, The Fourth Central Hospital of Tianjin, Tianjin 300140, ChinaDepartment of Neurology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing 100050, ChinaDepartment of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, ChinaDepartment of Neurology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing 100050, ChinaDepartment of Neurology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing 100050, ChinaDepartment of Neurology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing 100050, ChinaDepartment of Neurology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing 100050, ChinaThe Center for Translational Research on Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, ChinaDepartment of Neurology, Methodist Neurological Institute, Houston, TX 77030, USA; Corresponding author.Objective: Pontine infarction is a common type of stroke in the cerebral deep structures, resulting from occlusion of small penetrating arteries, may manifest as hemi-paralysis, hemi-sensory deficit, ataxia, vertigo, and bulbar dysfunction, but patients presenting with restless legs syndrome (RLS) are extremely rare. Herein, we reported five cases with RLS as a major manifestation of pontine infarction. Methods: Five cases of pontine infarction related RLS were collected from July 2013 to February 2016. The diagnosis of RLS was made according to criteria established by the International RLS Study Group (IRLSSG) in 2003. Neurological functions were assessed according to the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Severity of RLS was based on the International RLS Rating Scale (IRLS-RS). Sleep quality was assessed by Epworth Rating Scale (ERS), and individual emotional and psychological states were assessed by Hamilton Depression Scale (HDS) and Hamilton Anxiety Scale (HAS). Results: The laboratory data at the onset including hemoglobin, serum concentration of homocysteine, blood urea nitrogen (BUN), creatinine, electrolytes, and thyroid hormones were normal. The electroencephalogram (EEG), lower-extremity somatosensory evoked potential (SEP), and nerve conduction velocity (NCV) in four limbs were normal. The average period of follow-up was 34.60 ± 12.76 months. The MRI examination showed acute or subacute pontine infarction lesions, 3 cases in the rostral inner side, 1 case in the rostral lateral and inner side, and 1 case in rostral lateral side. The neurological deficits included weakness in 4 cases, contralateral sensory deficit in 1 case, and ataxia in 2 cases. All 5 patients presented with symptom of RLS at or soon after the onset of infarction and 4 patients experienced uncomfortable sensations in the paralyzed limbs contralateral to the ischemic lesion. Their neurological deficits improved significantly 2 weeks later, but the symptoms of RLS did not resolve. Among them, 3/5 patients were treated with dopaminergic drugs. At the end of the follow-up, RLS symptom eventually resolved in 3 patients but persisted in two. The IRLS-RS, NIHSS and mRS scores were significantly lower at the onset than those at the last follow-up (P = 0.035, 0.024 and 0.049, respectively). However, there was no significant difference in the ERS, HDS and HAS scores (P = 0.477, 0.226 and 0.778, respectively). Conclusion: RLS can be an onset manifestation of pontine infarction, clinicians should be aware of this potential symptom. RLS usually occurs in the paralyzed limbs contralateral to the infarction lesion. The pathogenesis still needs further investigation. Keywords: Restless legs syndrome, Pontine infarction, Clinical featureshttp://www.sciencedirect.com/science/article/pii/S2095882X17300609 |
| spellingShingle | Hou-Zhen Tuo Ze-Long Tian Yi-Nong Cui Xiao-Yang Ma Chun-Ling Xu Hong-Yan Bi Li-Yan Zhang Yong-Bo Zhang Wei-Dong Le William Ondo Restless legs syndrome secondary to pontine infarction: Clinical analysis of five cases Chronic Diseases and Translational Medicine |
| title | Restless legs syndrome secondary to pontine infarction: Clinical analysis of five cases |
| title_full | Restless legs syndrome secondary to pontine infarction: Clinical analysis of five cases |
| title_fullStr | Restless legs syndrome secondary to pontine infarction: Clinical analysis of five cases |
| title_full_unstemmed | Restless legs syndrome secondary to pontine infarction: Clinical analysis of five cases |
| title_short | Restless legs syndrome secondary to pontine infarction: Clinical analysis of five cases |
| title_sort | restless legs syndrome secondary to pontine infarction clinical analysis of five cases |
| url | http://www.sciencedirect.com/science/article/pii/S2095882X17300609 |
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