J Korean Med Sci.  2008 Jun;23(3):533-536. 10.3346/jkms.2008.23.3.533.

A Case of a Patient with Both Chorea and Restless Legs Syndrome

• Shin YK
• Hong SC
• Ihn YK
• Jeong JH
• Han JH
• Lee SP

• KMID: 1786897
• DOI: http://doi.org/10.3346/jkms.2008.23.3.533

Abstract

The patient was a 44-yr-old man with end-stage renal disease who had developed chorea as a result of hypoglycemic injury to the basal ganglia and thalamus and who was subsequently diagnosed with depression and restless legs syndrome (RLS). For proper management, the presence of a complex medical condition including two contrasting diseases, chorea and RLS, had to be considered. Tramadol improved the pain and dysesthetic restlessness in his feet and legs, and this was gradually followed by improvements in his depressed mood, insomnia, lethargy, and feelings of hopelessness. This case suggests that the dopaminergic system participates intricately with the opioid, serotoninergic, and noradrenergic systems in the pathophysiology of RLS and pain and indirectly of depression and insomnia.

Keyword

Restless Legs Syndrome; Chorea; Sleep Initiation and Maintenance Disorde; Depression; Tramadol

MeSH Terms

Adult
Analgesics, Opioid/therapeutic use
Anti-Dyskinesia Agents/therapeutic use
Chorea/*complications/pathology
Citalopram/therapeutic use
Drug Therapy, Combination
Haloperidol/therapeutic use
Humans
Kidney Failure, Chronic/*complications
Magnetic Resonance Imaging
Male
Restless Legs Syndrome/*complications/drug therapy/pathology
Serotonin Uptake Inhibitors/therapeutic use
Tramadol/therapeutic use

Figure

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  Fig. 1 Axial T2-weighted MR image demonstrates a high signal intensity change in the head of the caudate nucleus and putamen bilaterally and reveals old lacunar infarctions of the bilateral thalamus.

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  Fig. 2 Follow-up T2-weighted imaging performed 4 weeks later, demonstrating resolution of previously noted basal ganglia lesions and residua of the hyperintensity change in the left putamen.

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