Disclosures: Amanda E. Hanekom, MD: Nothing to disclose

Case Description: Review of research on ischemic and hemorrhagic strokes as well as animal studies focusing on the clinical manifestations of caudate injury have reported impairments in behavior, cognition, and movement modulation. There is evidence of a link between acquired lesions of the caudate and hyperkinetic moment disorders.

Setting: The patient was accepted to inpatient rehabilitation and efforts were initially focused on the patient’s physical, cognitive, behavioral, nutritional, medical, and sleep hygiene needs.

Patient: Here we examine the case of a 30-year-old male who sustained penetrating head trauma from a grenade blast. Due to adequate arousal and risk of seizures from penetrating head injury, patient’s amantadine was discontinued. Oxycodone and Fentanyl were also tapered off due to negative cognitive impact. Shortly afterward, the patient developed increasing restlessness and psychomotor agitation described as a "pins and needles" discomfort during periods of inactivity, worse in the evenings, and transiently relieved by movement.

Assessment/Results: Imaging studies demonstrated injury to multiple areas of the brain including the right anterior portion of the caudate.

Discussion: With the assistance of Neuropsychiatry, it was postulated that the patient had developed an aggressive form of restless leg syndrome (RLS) activated by injury to the caudate. RLS was felt to be unmasked following the discontinuation of Amantadine and high dose opiate medication. The circadian specificity and primary involvement of the legs was inconsistent with akathisia. Therefore, traditional serotonergic agents and beta-blockers were ineffective. The patient was subsequently started on Amantadine and Pramipexole for dopaminergic supplementation. Within one week, the patient’s symptoms resolved.

Conclusion: This case demonstrates the vitality of the caudate nucleus within the basal ganglia system and its impact on behavior, cognition, physical function, and involuntary movement control. We identified a patient who sustained unilateral, traumatic injury to the caudate with development of disabling restless leg syndrome whose symptoms resolved with dopaminergic medication.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-case-of-intractable-restless-leg-syndrome-following-unilateral-caudate-injury/