Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A 70-year-old woman presenting with restless shoulder following posterior internal capsule infarction

Takeo Matsubara, M.D.1), Keisuke Suzuki, M.D., Ph.D.1), Madoka Okamura, M.D., Ph.D.1), Tomohiko Shiina, M.D.1), Masayuki Miyamoto, M.D., Ph.D.2), Toshiki Nakamura, M.D., Ph.D.3) and Koichi Hirata, M.D., Ph.D.1)

1)Department of Neurology, Dokkyo Medical University
2)Department of Clinical Medicine for Nursing, Dokkyo Medical University School of Nursing
3)Department of Neurology, Rehabilitation Amakusa Hospital

A 70-year-old woman noticed difficulty in speech and weakness of the left upper and lower limb upon awakening. Neurological examination showed dysarthria and left hemiparesis. No sensory disturbance was observed. Brain MRI revealed acute infarction in the right posterior limb of the internal capsule. On the hospital day 1, she developed the abnormal sensations restricted to the bilateral shoulders, resulting in difficulty initiating sleep. On laboratory data, renal function and serum hemoglobin and ferritin levels were normal. When four essential features of restless legs syndrome (RLS) were applied to her shoulders, the patient met RLS criteria. Following low dose pramipexole treatment, the abnormal sensation of the shoulders and insomnia significantly improved. We should be aware of the possibility of RLS or its variant, including "restless shoulder" of our patient, for the cause of insomnia following acute ischemic infarction.
Full Text of this Article in Japanese PDF (416K)

(CLINICA NEUROL, 57: 711|715, 2017)
key words: restless shoulder, posterior internal capsule infarction, restless legs syndrome

(Received: 10-Apr-17)