Limb-Shaking Transient Ischemic Attacks in a Case of Brachiocephalic Artery Stenosis

Limb-shaking transient ischemic attacks represent an atypical presentation of transient ischemic attacks usually seen with carotid artery stenosis but may occur in severe brachiocephalic stenosis.

We present the case of a 67-year-old woman with severe brachiocephalic artery stenosis but no significant right carotid disease with a 2-year history of alternating movements of the left upper and lower limbs with postural changes culminating in a large-vessel stroke, with resolution of the alternating movements after a left-to-right subclavian bypass.

Only 4 cases of limb-shaking transient ischemic attacks secondary to subclavian/brachiocephalic artery stenosis have been described in literature. Cardiologists often see these patients in the vascular clinic. If recognition of these shaking movements in the context of transient ischemic attacks is missed, it can lead to a delay in appropriate intervention, thereby increasing the future risk of stroke.

Proximal vessel stenosis can lead to TIAs. Timely recognition and early intervention (preferably surgical) in cases of brachiocephalic/subclavian stenosis with LSTIAs is important as it can be crucial for stroke prevention.