Key result
Antihypertensive adjustment and DAPT prevent recurrent limb shaking in severe carotid stenosis with postural hypotension.
Case Report (n=1)
No
Limb shaking TIAs are an unusual presentation of transient cerebral hypoperfusion associated with severe carotid artery stenosis, and early diagnosis is crucial to prevent ischemic stroke.
Single-case report supports targeted medical optimization; hypothesis-generating and should not yet change practice.
First described by Fischer in 1962, the limb shaking syndrome is a haemodynamic transient ischaemic attack (TIA) clinically characterised by brief, dysrhythmic, flailing or jerking movements, involving limbs contralateral to an occlusion of the internal carotid artery (ICA), which occur with a change in posture such as standing from sitting. We present the case of a woman in her 60s who presented with left-sided weakness suggestive of right hemispheric stroke, with previous episodes of limb shaking TIAs, which were caused by significant cerebral hypo-perfusion due to a combination of postural hypotension and a significant stenosis of the left ICA.
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Manocha et al. (2022) conducted a case report in Limb shaking transient ischaemic attack (TIA) (n=1). Antihypertensive medication adjustment and dual antiplatelet therapy was evaluated on Recurrence of limb shaking episodes. Adjustment of antihypertensive medications and initiation of dual antiplatelet therapy prevented further limb shaking episodes in a patient with severe carotid stenosis and postural hypotension.
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