Limb-Shaking Transient Ischemic Attack Associated with Focal Electroencephalography Slowing: Case Report

Abstract

Background: Limb shaking is a rare form of transient ischemic attack (TIA) that can easily be confused
with focal motor seizures. Case: We report a case of a 61-year-old man with rhythmic jerky movements of
his left limb, without loss of awareness, that have occurred about once per month for the past four months,
precipitated by standing up and extending the neck. The electroencephalography test showed right temporal
slow activity, without epileptiform features. No evidence of a noteworthy structural lesion was found on
magnetic resonance imaging of the brain. Doppler ultrasound and magnetic resonance angiography of the
neck disclosed an 80% stenosis of the right internal carotid artery. The patient underwent an endarterectomy of the right internal carotid artery and remained asymptomatic in the 12-month follow-up period.
Discussion: Both hypoperfusion and reduction of vasomotor reactivity to hypercapnia of corresponding
cerebral territories, without the structural lesions of the brain, were observed in patients with limb-shaking
syndrome (LSS). Electroencephalographic studies have failed to show epileptiform activity associated with
LSS, although some patients have controlateral slow activity. In our patient, we observed a resolution of the
attacks after endarterectomy of controlateral internal carotid artery, suggesting that a quick diagnosis of this
form of TIA is important both to abolish the attacks and to reduce the risk of major stroke.