Thursday, April 25, 2013
A 50 year old woman with major depressive disorder, iron deficiency, and anemia complains of lower leg discomfort at rest. Movement relieves the discomfort. This discomfort occurs in both legs and is described as "crawling, creeping, pulling, or stretching" deep under the skin. There is no pain, numbness, tingling, or increased sensitivity of the skin. The symptoms are worst at night, about 20 minutes after getting in bed. She also complains of insomnia and daytime sleepiness. A sleep study is negative for obstructive sleep apnea, but finds the trace shown above. The blue is a normal sleep pattern while the red is the patient's sleep pattern. In addition, the patient has sudden jerking leg movements with extension of the toes and flexion of the ankle and knee that last a few seconds but repeat in clusters. The rest of the neurologic exam is normal.
Challenge: What's your diagnosis?
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