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?
Image shown under Creative Commons Attribution Share-Alike License.
Restless leg syndrome:
ReplyDelete1. There is an association between IDA and RLS. (Women are prone to RLS during pregnancy due to increased blood volume--physiologic anemia)
2. The characteristics of RLS are discomfort when resting with no focal neurological changes. It gets worse at the end of the day.
3. The sleep study showed no stage III and IV of NREM sleep because the muscle jerks wake her up periodically (10 times in total! that is some jumpy sleeping she was having)
restless leg syndrome
ReplyDeleteWillis-Ekbom. AKA; Restless Leg Syndrome.
ReplyDeleteof course! i get those muscle jerks /periodic sleep movements sometimes too...
ReplyDelete-
Twitchy
This is restless legs syndrome, symptoms of spontaneous, continuous leg movements associated with unpleasant paresthesias. She also has periodic limb movements of sleep.
Sources: UpToDate; Wikipedia.