gms | German Medical Science

Objective: Restless legs syndrome (RLS) is one of the most common neurological diseases that affects up to 4,5 % of the general population. Symptoms mainly consist of abnormalities in sensation and motor activity. Diagnostic criteria include an urge to move, uncomfortable sensations, motor restlessness, worsening of symptoms during relaxation and in the evening. RLS occurs in association with other diseases and conditions, in particular iron deficit, pregnancy, uremia, severe liver dysfunction, thyroid dysfunction, peripheral polyneuropathy, multiple sclerosis, Parkinson´s disease and rheumatoid arthritis. We present the case of a patient suffering from RLS for several years and being relieved from these symptoms after removal of a meningioma that had compressed lower brainstem and upper spinal cord.

Methods: This 52-year-old woman reported symptoms consistent with RLS for 10 years duration. Initially, she felt an urge to move her legs only during long car rides. Simultaneously, prickling and tingling sensations developed in her thighs. Subsequently, symptoms also developed when sitting on a chair and lying in her bed. The discomfort was pronounced during evening and in situations of physical inactivity. Family history was positive, her father as well as her identical twin suffered from RLS. As additional symptoms, the patient mentioned difficulty to empty the bladder. Blood analyses excluded iron deficit, liver, thyroid or kidney dysfunction. On the International RLS severity scale. she scored 37 (out of a maximum of 40) points. Approximately 3 months later, she developed additional impairments in co-ordination and strength, pain in the cervical spine and a paresis of her left sided toes. A magnetic resonance imaging of the brain was performed. It showed a large tumor located above and below the foramen magnum, compressing medulla oblongata and upper spinal cord .

Results: The tumor was successfully removed without side effects. Histologic analysis classified the tumor as an angiomatous meningioma. Immediately after surgery, RLS symptoms disappeared completely. Four weeks post- surgery she still scored 0 points on the International RLS severity scale.

Conclusion: To our knowledge, this is the second report on a tumor evoking RLS symptoms. RLS pathophysiology is still under discussion. Presumably, several mechanisms play a role. A central disorder of sensory-motor integration and a functional deficit of dopaminergic pathways are suspected. Interestingly, a recent study suggested microstructural alterations in the midbrain and in the upper spinal cord of RLS patients. Rarely, RLS symptoms might be the first indicator of a tumor located at the foramen magnum level. We speculate that susceptibility for RLS is a prerequisite since both patients had a positive family history. Possibly, compression by the tumor had affected dopaminergic descending pathways.