Symptomatic restless leg syndrome after lacunar stroke

After suffering a microangiopathic lacunar ischemic stroke within the left-hemispheric thalamus, a patient newly developed a strictly unilateral symptom complex of the contralateral right leg: Paresthesias and dysesthesias of the right leg, distal to the knee only during resting periods at night accompanied with the urge to move the leg and resulting insomnia. The symptoms were completely relieved by walking, fulfilled all essential criteria for restless leg syndrome (RLS) and were also responsive to dopaminergic treatment. MRI of the brain showed the lacunar lesion in the left thalamus, mainly localized in the ventrolateral nucleus. Diffusion tensor imaging (DTI), visualizing cerebral white matter fibers, demonstrated a partial discontinuation of the white matter connections between brainstem, thalamus, and cortex within the area of the lesion. For the first time, a well-defined focal brain lesion was identified to cause RLS as one element within the still undetermined pathoanatomy of this disorder.