A Rare Presentation of a Patient with Limb-Shaking TIA due to Severe Carotid Artery Stenosis

Abstract

Background: A limb-shaking Transient Ischemic Attack (TIA) is a rare neurological symptom of hemodynamic origin caused by severe carotid artery disease. Physicians should be aware of its presence because it has a non-typical presentation and is cured by endarterectomy or stent- ing of the stenosed carotid artery. The aim of the present study was to describe a rare case of limb-shaking TIA. Description of case: A 76 year-old man with a 80% right internal carotid artery stenosis pre- sented with numerous episodes of involuntary jerky movements of his left arm and leg, associ- ated with episodes of brief weakness of the left leg, caused by preoperative optimization of his hypertension. No stroke ensued despite the daily appearance of symptoms for several months. Limb-shaking TIA was diagnosed and all symptoms disappeared immediately after an uncom- plicated carotid endarterectomy was performed. Conclusion: The clinical presentation of this limb-shaking TIA case, the first to our knowledge to appear during treatment of hypertension, supports further the hemodynamic theory of limb- shaking TIAs.