Question of the Week # 358

358)  A 36 year old man presents to your office for an annual health examination. During review of systems, he reports  feeling excessively sleepy during the day and forgetful at work. He states no matter how much he slept, it  does not make him feel rested in the morning. He denies snoring at night. He is athletic and maintains his body weight in a healthy range. He denies alcohol consumption, smoking or excessive caffeine use. His girlfriend reports that he abruptly moves his legs often during the night and that disturbs her as well. She has noticed him flexing his leg and extending his great toe repeatedly. The patient is not aware of this and he denies any pain or discomfort in his legs. Physical examination is unremarkable. Laboratory investigations including complete blood count, serum creatinine, electrolytes and a thyroid stimulating hormone are within normal limits. Which of the following is the most likely diagnosis?

A) Complex Partial Seizures

B) Restless leg syndrome

C) Nocturnal Leg Cramps

D) Myoclonus

E) Periodic Limb Movement Disorder

F) Sleep Apnea

7 Responses

  1. B) Restless leg syndrome

  2. oops its

    E) Periodic Limb Movement Disorder

    • he does not have the itching or tickling sensation and the pt is not aware of it…so its E

  3. Sleep Apnea

  4. E) Periodic Limb Movements Disorder
    extension of the great toe and dorsiflexion of the foot recurring every 20-40sec during non-REM sleep. Treatment is dopaminergic medication or benzodiazepines.

  5. e) Periodic limb movement disorder

  6. e

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