Limb-shaking transient ischemic attack

Abstract

Limb shaking Transient Ischemic Attack is a rare manifestation of carotid-occlusive disease. The symptoms usually present with seizure like activity and often misdiagnosed as focal seizures. Only on careful history the important clinical clues-which may help in differentiating from seizure-are revealed: Lack of Jacksonian march or aura; precipitation by maneuvers that lead to carotid compression. We present the case of an elderly gentleman with recurrent limb shaking transient ischemic attacks that was initially diagnosed as a case of epilepsy. His symptoms responded to optimization of blood pressure. The case report highlights the importance of accurate diagnosis as the treatment of the associated carotid artery occlusion may not only abolish the attacks but also reduce the risk of future stroke.

Keywords: Carotid occlusion; hypertension; limb-shaking transient ischemic attack; seizure mimics; stroke; transient ischemic attack.

Figure 1

(a-b) MRI Brain (Axial section FLAIR sequence) showing infarcts in left periventricular region and centrum semiovale, (c) contrast MR angiography showing bilateral proximal internal carotid artery stenosis [(R) ICA – arrowhead, (L) ICA – arrow]