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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	KeAi Communications Co., Ltd. 2017
Materias:	Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/9b7c5e037cbb41b09a8a1f273b1da1a9
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spelling	oai:doaj.org-article:9b7c5e037cbb41b09a8a1f273b1da1a92021-12-02T13:58:44ZRestless legs syndrome secondary to pontine infarction: Clinical analysis of five cases2095-882X10.1016/j.cdtm.2017.08.001https://doaj.org/article/9b7c5e037cbb41b09a8a1f273b1da1a92017-09-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2095882X17300609https://doaj.org/toc/2095-882XObjective: 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 featuresHou-Zhen TuoZe-Long TianYi-Nong CuiXiao-Yang MaChun-Ling XuHong-Yan BiLi-Yan ZhangYong-Bo ZhangWei-Dong LeWilliam OndoKeAi Communications Co., Ltd.articleMedicine (General)R5-920ENChronic Diseases and Translational Medicine, Vol 3, Iss 3, Pp 186-190 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine (General) R5-920
spellingShingle	Medicine (General) R5-920 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
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
format	article
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
title	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_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_sort	restless legs syndrome secondary to pontine infarction: clinical analysis of five cases
publisher	KeAi Communications Co., Ltd.
publishDate	2017
url	https://doaj.org/article/9b7c5e037cbb41b09a8a1f273b1da1a9
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_version_	1718392216534122496

Restless legs syndrome secondary to pontine infarction: Clinical analysis of five cases

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