[Limb-shaking movement disorder - an unusual presentation during transient ischemic attack]

Involuntary movements are an uncommon manifestation of transient ischemic attacks (TIAs) and are often associated with carotid occlusion or stenosis. These symptoms are frequently position-dependent, typically occurring when the patient stands or becomes hypotensive, and can be misdiagnosed as focal motor seizures. Patients presenting with this phenomenon may be at a high risk of recurrent stroke due to underlying carotid disease. We present the case of a 79-year-old woman who exhibited hyperkinetic movements on her left side. Her symptoms appeared upon transitioning from sitting to standing and were exacerbated following more aggressive antihypertensive treatment. Diagnostic imaging revealed a near-occlusion of her right carotid artery and multiple ischemic lesions in the right cerebral hemisphere. She was admitted for carotid endarterectomy, after which she became symptom-free.