Bilateral internal carotid artery stenosis presenting as Limb-Shaking syndrome

Estenosis bilateral de carótidas internas manifestado por síndrome de Limb-Shaking

Limb-shaking syndrome or involuntary shaking movements of the affected limbs as a manifestation of a transient ischemic attack is rare and often is associated with internal carotid artery stenosis. The main differential diagnosis is a convulsive seizure. We present the case of a patient with bilateral intracranial carotid artery stenosis presenting as limb shaking syndrome, showing satisfactory clinical improvement after undergoing stent revascularization.

1. Yanagihara T, Piepgras DG, Klass DW. Repetitive involuntary movement associated with episodic cerebral ischemia. Ann Neurol. 1985;18(2):244-50. doi:10.1002/ana.410180212
2. Javaid A, Alfishawy M. Internal Carotid Artery Stenosis Presenting with Limb Shaking TIA. Case Rep Neurol Med. 2016;2016:3656859. doi: 10.1155/2016/3656859
3. Fisher CM. Concerning recurrent transient cerebral ischemic attacks. Can Med Assoc J. 1962;86:1091-9.
4. Kim SH, Han SW, Heo JH. Predictive implications of recurrent transient ischemic attacks in large-artery atherosclerosis. Cerebrovasc Dis. 2006;22(4):240-4. doi: 10.1159/000094010
5. Rosenbaum S, Ovesen C, Futrell N, Krieger DW. Inducible limb-shaking transitory ischemic attacks: a video-documented case report and review of the literature. BMC Neurol. 2016;16:78. doi: 10.1186/s12883-016-0601-8
6. Zaidat OO, Werz MA, Landis DM, Selman W. Orthostatic limb shaking from carotid hypoperfusion. Neurology. 1999;53(3):650-1. doi: 10.1212/wnl.53.3.650
7. Das A, Baheti NN. Limb-shaking transient ischemic attack. J Neurosci Rural Pract. 2013;4(1):55-6. doi: 10.4103/0976-3147.105615
8. Schulz UG, Rothwell PM. Transient ischaemic attacks mimicking focal motor seizures. Postgrad Med J. 2002;78(918):246-7. doi: 10.1136/pmj.78.918.246
9. Persoon S, Kappelle LJ, Klijn CJ. Limb-shaking transient ischaemic attacks in patients with internal carotid artery occlusion: a case-control study. Brain. 2010;133(Pt 3):915-22. doi: 10.1093/brain/awq009
10. Persoon S, Kappelle LJ, Klijn CJM. Limb-Shaking Transient Ischaemic Attacks in Patients With Internal Carotid Artery Occlusion: A Case-Control Study. Journal of Vascular Surgery. 2010;52(3):798. doi: 10.1016/j.jvs.2010.07.039
11. Ma QF, Huang Q, Zhang Q, Fan CQ, Guo XH, Wu J. Association between clinical features and prognosis of patients with limb-shaking transient ischemic attack. Chin Med J (Engl). 2013;126(22):4354-7.