Brainstem Stroke-Related Restless Legs Syndrome: Frequency and Anatomical Considerations

Abstract

Background: Given the discordant results of studies that have reported cases of RLS associated with brainstem stroke and the absence of RLS in large series describing the clinical spectrum of brainstem infarctions, we decided to assess RLS in all patients admitted for brainstem stroke. Methods: All patients who were consecutively referred to the Strasbourg stroke unit for brainstem infarction were prospectively evaluated for RLS. The different parameters analyzed were the topography of the ischemic lesions (magnetic resonance imaging), the different symptoms (sensory, motor, cerebellar, cranial nerves and dysarthria) and the NIH stroke scale. Statistical analyses used the Bayesian paradigm. Results: Thirty patients have been included, and RLS was observed in three patients (10%). Two patients suffered from an exacerbation of symptoms anterior to the stroke, and the other patient a de novo, but transient, RLS. Patients with stroke-induced sensory symptoms have a higher risk to develop brainstem stroke-related RLS as compared to patients without sensory symptoms. Conclusion: The results suggest that RLS should be systematically screened in patients affected with brainstem stroke, especially in the case of stroke-induced sensory symptoms. Clinicians should be aware of this association, especially as efficient treatments are available and allow improving the management of patients affected with stroke. i 2014 S. Karger AG, Basel

Post-stroke restless leg syndrome and periodic limb movements in sleep

“…After five cases (including two of the present study) with concurrent RLS and PLMS were excluded, data on the remaining 31 cases of isolated psRLS (22 cases) or isolated psPLMS (nine cases, including the three cases of the present study) were analyzed. PLMS was confirmed by polysomnography in six cases, by clinical observation in three, and by video recording in two . Polysomnography was not performed on any reported psRLS case .…”

Narrative review of sleep and stroke

“…The prevalence of RLS in stroke patients has been estimated to be at around 2-12% (80)(81)(82)(83)(84). Importantly, the presence of post-stroke RLS seems to lead to worse reported quality of life, independently from functional situation and depression (85).…”

“…The location of the stroke may contribute to the development of RLS or PLMS. Areas such as the brainstem, thalamus, basal ganglia, and corona radiata, have all been reported as probably involved in post-stroke RLS/ PLMS, and may influence in the laterality of these (83,86).…”

Features of Circadian Rhythms in Patients with Cerebrovascular Diseases

“…To date, specific mechanisms for increasing cardiovascular risk in restless legs syndrome have been described: (1) periodic movements of limbs in a dream, accompanied by a significant increase in the heart rate and BP; (2) fragmentation of sleep and lack of sleep, invoking changes in the regulation of nervous and vascular systems, metabolism, oxidative, inflammatory processes; (3) iron deficiency, which creates new risks for CVP [90][91][92].…”