Complete resolution of restless legs syndrome following ischemic stroke of the right middle cerebral artery

Stroke-related restless legs syndrome (sRLS) is an emerging clinical entity, with a clear relationship between stroke and the occurrence of restless legs syndrome (RLS). Dopamine dysregulation has been observed in sRLS of the lenticulostriate region with increased dopamine precursor and decreased dopamine transporter. The aim of this work is to explore an original case of regressive RLS following stroke. Anatomical (MRI) and functional (¹⁸F-FDG PET; ¹⁸F- FDOPA PET; ¹²³I-FP-CIT SPECT) brain imaging was performed in our patient. A 63 year-old woman experienced complete resolution of longstanding restless legs syndrome (RLS) after a right middle cerebral artery stroke (left faciobrachial sensorimotor deficit), efficiently treated with intravenous thrombolysis. Having had RLS for 14 years, she reported complete symptom relief within four days post-stroke. 2 year follow-up confirmed sustained improvement. In our patient, functional dopaminergic imaging revealed an overall normal dopaminergic tone. This case contradicts the more commonly reported scenario of sRLS where stroke leads to the onset or worsening of RLS. The pathophysiology of RLS remains unclear and in the absence of clear biomarkers for RLS, small lesion models in humans can provide valuable insights to a better understanding of this disease.