534 imaging (MRI) scans showed high signal changes over the bilateral basal ganglia and right thalamus, although abnor- mal enhancing lesions were not found after contrast infusion (Fig. 1). The patient was diagnosed with hypoglycemic injury of both basal ganglia and the right thalamus and received conservative medical treatment. One week later, he present- ed to the psychiatric department complaining of depression and insomnia. He was depressed and feeling hopeless and had severe sleep disturbance and thoughts of suicide. He was transferred to the psychiatric ward. He complained that the most distressing problem was the difficulty in falling asleep and staying asleep because of the dysesthetic restless- ness. He satisfied the diagnostic criteria for RLS in the Interna- tional Classification of Sleep Disorders (2). He was prescrib- ed citalopram 20 mg for depression, gabapentin 900 mg, and clonazepam 0.5 mg for peripheral neuropathy and RLS, oral iron supplements for iron deficiency anemia and RLS, and haloperidol 1.5 mg for choreic movements, and received daily supportive psychotherapy. Also, he received hemodial- ysis three times a week. The dysarthria and involuntary hyperkinetic movements gradually improved over his whole body, except for his left arm. The pain in his feet remained severe, and the dysesthet- ic restlessness continued in his lower legs. He still suffered from insomnia and depression. Four weeks later, follow-up T2-weighted MRI scans showed resolution of previously noted basal ganglia lesions, residua of the hyperintensity change in the left putamen, and an infarction as an old lesion in the right thalamus (Fig. 2). The patient showed increased deep tendon reflexes on neurological examination as well as Y.-K. Shin, S.-C. Hong, Y.K. Ihn, et al. delayed latencies and small amplitudes for complex muscle action potential and sensory nerve action potential on a nerve conduction test, suggesting peripheral polyneuropathy. He then underwent a nocturnal polysomnography to examine the causes of his insomnia. When he lay down for polysomno- graphic evaluation, he experienced dysesthetic sensations and an irresistible inner urge to move his legs, as usual. The patient complained that he could not endure the dysesthetic sensations and was given his usual medications before bed: gabapentin 300 mg, clonazepam 0.5 mg, citalopram 10 mg, and haloperidol 1.5 mg. The patient fell asleep 18.3 min after taking the medications. His total sleep time was 391.0 min, and sleep efficiency was 80.4%. There were 55.2 peri- odic limb movements per hour in sleep, and about 36% of them led to arousal. The complete diagnoses of the patient included chorea, peripheral polyneuropathy, RLS, periodic limb movement disorder, insomnia, and depression. During those days, his serum hemoglobin, iron, and ferritin levels were nearly normal: 11.4 g/dL, 62.0 μg/dL, and 210.0 ng/ mL, respectively. Although gabapentin, clonazepam, oral iron supplements, citalopram, and haloperidol were prescribed for 4 weeks, the pain, dysesthetic sensations, insomnia, and depression con- tinued. To make matters worse, the choreic movements were aggravated. An increase in the dosage of haloperidol from 1.5 to 3 mg was prescribed. However, the choreic movements did not improve, and the dysesthetic restlessness, insomnia, and depression worsened. The haloperidol was reduced to 1.5 mg, and the gabapentine was replaced with carbamaze- pine 400 mg and topiramate 25 mg. However, there was no Fig. 1. Axial T2-weighted MR image demonstrates a high signal intensity change in the head of the caudate nucleus and puta- men bilaterally and reveals old lacunar infarctions of the bilateral thalamus. Fig. 2. Follow-up T2-weighted imaging performed 4 weeks later, demonstrating resolution of previously noted basal ganglia lesions and residua of the hyperintensity change in the left putamen.