CASE REPORT Restless Legs Syndrome and lateralized periodic movements due to a spinal schwannoma Anna LOSURDO, Marco LUIGETTI, Domenico RESTUCCIA, Catello VOLLONO, Elisa TESTANI, Valentina GNONI, Chiara DI BLASI and Giacomo DELLA MARCA Institute of Neurology, Catholic University, Rome, Italy Abstract We describe a case of Restless Legs Syndrome (RLS) associated to periodic limb movements (PLMs) in a woman with a cervical schwannoma. Neurological examination, laboratory tests, neurography and electromyography were unremarkable. Neuroimaging evidenced a schwannoma at C3 level that compressed the right ventral surface of the medulla. Somatosensory-evoked potentials showed absence of the N13 after right median nerve stimulation and reduction of amplitude of the same component after left nerve stimulation. A video-polysomnography documented PLMs with a marked prevalence of the right-sided movements. We believe that the cervical schwannoma played a role in the pathogenesis of RLS and of lateralized PLMs. Key words: cervical schwannoma, periodic limb movements, Restless Legs Syndrome, somatosensory evoked potentials. INTRODUCTION Restless Legs Syndrome (RLS) is a sensorimotor disorder characterized by compelling urge to move the limbs and unpleasant sensations involving predominantly the lower limbs. It is often associated with Periodic Limb Movements (PLMs) in wake and sleep. An association with spinal lesions has been reported. 1,2 CASE REPORT A 72-year-old woman referred nocturnal motor restless- ness and painful paraesthesias at the lower limbs, bilat- eral and symmetric, that urged her to walk around to obtain relief. The symptoms occurred daily and occasion- ally involved her arms. Arterial hypertension, osteoporo- sis, surgical intervention for carpal tunnel syndrome and thyroidectomy were reported. Neurological examination was unremarkable. Creatinine, serum iron levels, ferritin, transferrin were normal. Nerve conduction studies in all limbs were normal, including the previously decom- pressed median nerve. Electromyography of trapezius, deltoid, biceps brachialis and extensor digitorum communis showed no spontaneous activity and a normal recruitment pattern. A neck CT scan, performed for her thyroid pathology, revealed a paravertebral formation. Spine Magnetic Resonance Imaging (MRI) showed an intradural, extramedullary right paramedian round for- mation (7 × 9 × 3.5 mm), with homogeneous contrast enhancement, adjacent to the posterior soma of C3, impressing the ventral surface of the medulla (Fig. 1a–c). Possible diagnosis for intradural, extramedullary lesions are Schwannoma (30%), Meningioma (25%) or Neurofi- broma. 3 Schwannomas are iso-hypointense in T1 and hyperintense in T2, have round shape and heterogeneous contrast enhancement. Meningiomas have broad dural attachment and iso- or mildly hyperintense signal in T2. Correspondence: Dr Anna Losurdo, Institute of Neurology, Catholic University, Policlinico Universitario “A. Gemelli” – Largo A. Gemelli, 8-00168 Rome, Italy. Email: annalosurdo@hotmail.it Conflicts of Interest: Authors have no funding source and no conflicts of interest. Accepted 26 December 2013. Sleep and Biological Rhythms 2015; 13: 106–108 doi:10.1111/sbr.12081 106 © 2014 The Authors Sleep and Biological Rhythms © 2014 Japanese Society of Sleep Research