262  Limb-shaking linked to haemodynamic cerebrovascular disease. Issue 6 (27th May 2022)

• Record Type: Journal Article
• Authors: Cleaver, Jonathan; Pope, Laura; Mayo, Thomas; Gbadamoshi, Lukuman
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 93:Issue 6(2022)
• Page Start: A89
• Page End: A89
• Publication Date: 2022-05-27
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2022-ABN.289
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Limb-shaking transient ischaemic attacks (TIAs) are under-recognised in neurology and typically consists of involuntary movements resembling focal seizure-like activity. This form of TIA suggests severe carotid occlusive disease and is a warning for future strokes. Awareness can help avoid unnecessary medication, lifestyle measures and driving implications. We present a case of a 61-year-old patient who developed transient but persistent right upper limb shaking and syncope on turning to the left. He suffered a recent NSTEMI causing severe left ventricular dysfunction and associated anaemia. His ictal EEG was unremarkable. CT angiography and doppler ultrasound revealed severe left internal carotid artery stenosis. This suggested an underlying low-flow TIA and symptoms resolved with blood pressure optimisation and blood transfusions. Cerebrovascular events typically present with acute negative symptoms including loss of power, sensation, vision or speech. Alternatively, focal movement abnormalities would generally make the physician think of a non-cerebrovascular disorder. This stresses the need to raise awareness of limb-shaking TIAs to expedite diagnosis and instigate management strategies to lower future stroke risk. Along with secondary stroke prevention, attacks can be abolished by improving blood supply through optimisation of blood pressure, cardiac function and treating anaemia. Failing this, surgical revasculari- sation procedures should be considered. [e-mail]