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Related Experiment Videos

Perfusion insufficiency in limb-shaking transient ischemic attacks.

T K Tatemichi1, W L Young, I Prohovnik

  • 1Department of Neurology, Columbia-Presbyterian Medical Center, New York, New York.

Stroke
|February 1, 1990
PubMed
Summary
This summary is machine-generated.

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Severe carotid artery disease can cause limb-shaking transient ischemic attacks due to hemodynamic failure. Treatment improved cerebral blood flow and vasoreactivity, suggesting a reversible mechanism.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Neuroimaging

Background:

  • Severe bilateral internal carotid artery disease can lead to transient ischemic attacks (TIAs).
  • Limb-shaking TIAs are rare and their underlying mechanism is not fully understood.

Observation:

  • A 63-year-old man presented with recurrent left limb shaking upon standing, associated with severe carotid artery disease.
  • Cerebral blood flow (CBF) studies revealed reduced resting flows and a focal perfusion deficit in the right hemisphere.
  • Transcranial Doppler ultrasonography showed reduced middle cerebral artery blood flow velocity and pulsatility index.
  • Impaired cerebrovascular reactivity was observed during hypercapnic challenge and induced hypotension.

Findings:

  • Reduced resting cerebral blood flow and impaired vasoreactivity were demonstrated in the affected hemisphere.

Related Experiment Videos

  • The focal perfusion deficit was most pronounced in the right dorsofrontal region.
  • Following carotid endarterectomy, CBF and vasoreactivity significantly improved.
  • These findings suggest a hemodynamic mechanism for the limb-shaking TIAs.

    • Implications:

    • Hemodynamic failure in border zone territories is a likely cause of limb-shaking TIAs in severe carotid artery disease.
    • Reversible deficits in cerebral perfusion and vasoregulation highlight the importance of addressing carotid stenosis.
    • This case underscores the utility of advanced neuroimaging and Doppler techniques in diagnosing and managing cerebrovascular disease.