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Cerebral Hemodynamic Failure Presenting as Limb-Shaking Transient Ischemic Attacks

By Max Nedelmann, Maren Kolbe, Daniel Angermueller, Wolfgang Franzen and Elke R. Gizewski


Limb-shaking transient ischemic attacks (TIA) may occur in patients with insufficient brain perfusion due to an underlying occlusive disease. We present the case of a 64-year-old patient who suffered from repetitive TIA presenting with shaking movements of the right-sided extremities and accompanying speech arrest. Symptoms are documented in the online supplementary video ( These episodes were frequently triggered in orthostatic situations. The diagnosis of limb-shaking TIA was established. The diagnostic workup revealed pseudo-occlusion of the left internal carotid artery, a poor intracranial collateral status and, as a consequence, an exhausted vasomotor reserve capacity. At ultrasound examination, symptoms were provoked by a change of the patient's position from supine to sitting. During evolvement of symptoms, a dramatic decrease of flow velocities in the left middle cerebral artery was observed. This case thus documents the magnitude and dynamics of perfusion failure in a rare manifestation of cerebral ischemic disease

Topics: Published: April 2011
Publisher: S. Karger AG
DOI identifier: 10.1159/000327683).
OAI identifier:
Provided by: PubMed Central

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