Objective To summarize the clinical and imaging features of secondary restless legs syndrome（ RLS） after acute cerebral infarction. Methods The clinical manifestations， MRI images and treatment plans of 20 patients with RLS after acute cerebral infarction treated by Beijing Friendship Hospital from January 2012 to January 2019 were analyzed retrospectively， to summarize their clinical features. Results The average age of the 20 patients with secondary RLS after acute cerebral infarction was（ 62.65±9.40） years old， including 12 males and 8 females， with a male to female ratio of 3∶2. The infarctions were located in the pons， radial crown， centrum semiovale， thalamus， putamen and occipital lobe. All 20 patients had limb paralysis on the contralateral side of the infarction， and 12 patients had dysesthesia of the limb contralateral to the infarct lesion. RLS occurred in the contralateral side of infarct in 12 patients and in both limbs in 8 patients. Among them， 15 patients were treated with dopaminergic drugs， and the clinical symptoms of RLS were significantly improved after treatment. Conclusions The common infarct sites of secondary RLS after acute cerebral infarction are the pons（ mostly parabrachial nucleus involvement）， centrum semiovale and basal ganglia. Compared with idiopathic RLS， secondary RLS after acute cerebral infarction is mostly unilateral， which can affect upper limbs， and dopaminergic drugs are effective.