Limb-shaking transient ischemic attack in posterior circulation ischemia: a case report

Area of Science:

• Neurology
• Vascular Neurology

Background:

• Limb-shaking transient ischemic attack (LS-TIA) is an uncommon presentation of cerebrovascular disease, typically associated with carotid artery stenosis.
• Reports linking LS-TIA to posterior circulation ischemia are exceptionally rare.

Observation:

• A 56-year-old male with epilepsy presented with dizziness, nausea, and vomiting.
• Initial MRI showed no acute ischemia; symptoms persisted despite treatment.
• During a vestibular test, the patient experienced sudden, isolated left-limb shaking without altered consciousness.

Findings:

• The limb shaking was unresponsive to anti-epileptic medication.
• Later, the patient developed left-limb paralysis, and MRI revealed brainstem infarction.
• The patient recovered with antiplatelet and antiatherosclerotic therapy.

Implications:

• This case demonstrates that posterior circulation ischemia can manifest as LS-TIA, expanding the differential diagnosis beyond carotid artery disease.
• Clinicians should suspect LS-TIA in patients with unexplained limb shaking, particularly with postural changes, even with a history of epilepsy.
• Prompt recognition and appropriate vascular management are crucial for favorable outcomes in LS-TIA patients.