1251 Restless Legs Syndrome Leading to Traumatic Brain Injury

Abstract

Introduction: Restless leg syndrome (RLS), a sensorimotor disorder characterized by an urge to move that is worse with rest and relieved by movement, follows a circadian pattern. This common, underdiagnosed disorder, affecting 5% of individuals globally and up to 15% of Caucasians, becomes more prevalent with increasing age, when risk of fall and patient safety are important concerns. Little is known about the risk for fall related to RLS. We present a case of RLS leading to a fall with consequent severe traumatic brain injury (TBI). Report of Case: A 56-year-old Caucasian gentleman with history of RLS presented to the emergency department after a fall. Earlier that night, he had been unable to sleep because of significant RLS symptoms. To relieve these symptoms, he walked around the house, and fell down a poorly-lit staircase, landing 8 feet below onto a cement floor, sustaining severe TBI. The resultant skull fracture, subarachnoid hemorrhage, and large subdural hematoma with pressure effects led to emergent craniotomy. Post-operative complications included seizures and respiratory failure requiring tracheotomy and gastrostomy tube placement. After extensive and prolonged rehabilitation, significant cognitive impairment with agitation, disinhibition, confabulation and short term memory loss continued; he was unable to return to his position as a university professor. Because of a fall that occurred while trying to obtain relief of RLS symptoms, this previously-high-functioning individual's life has changed. He now resides in a TBI facility and is no longer able to work or enjoy his previous family life. Conclusion: RLS is common and consequential, and should not be ignored. Its predilection for the evening hours and sensation of “restlessness” that cause many individuals to ambulate at night, may lead to an increased risk for falls. To ensure patient safety, RLS should be diagnosed and treated, especially in patients with advancing age.