[Hemodynamically-induced transitory ischemic attacks. A differential focal motor seizures diagnosis?]

This case report intends to focus attention on hemodynamic TIAs as cause of repetitive involuntary movements (RIMs) as differential diagnosis of simple partial motor seizures. We report two patients with episodic unilateral limb shaking lasting up to several minutes and which could be triggered by orthostasis, heat or physical exertion. Repeated EEG recordings revealed no epileptic discharges. In both patients, duplex ultrasonography revealed an occlusion of the internal carotid artery (ICA) contralateral to the side of the RIMs. Blood flow velocities in the middle cerebral artery ipsilateral to ICA occlusion were reduced and vasomotor reactivity to hypercapnia was absent. After elevation of blood pressure both patients became asymptomatic. We suggest that in patients with episodes of RIMs, Doppler sonography and tests of cerebral vascular reserve capacity should be performed to search for a hemodynamic origin of these symptoms.