Limb-shaking transient ischemic attacks: case report and review of literature

BACKGROUND: Limb shaking Transient Ischemic Attack is a rare manifestation of carotid-occlusive disease. The symptoms usually point towards a seizure like activity and misdiagnosed as focal seizures. On careful history the rhythmic seizure like activity reveals no Jacksonian march mainly precipitated by maneuvers which lead to carotid compression. We here present a case of an elderly gentleman who was initially worked up as suffering from epileptic discharge and then later on found to have carotid occlusion. CASE PRESENTATION: Elderly gentleman presented with symptoms of rhythmic jerky movements of the left arm and both the lower limbs. Clinical suspicion of focal epilepsy was made and EEG, MRI-Brain with MRA were done. EEG and MRI-Brain revealed normal findings but the MRA revealed complete occlusion of right internal carotid artery. On a follow-up visit jerky movements of the left arm were precipitated by hyperextension and a tremor of 3–4 Hz was revealed. Based on this the diagnosis of low flow TIA was made the patient was treated conservatively with adjustment of his anti-hypertensive and anti-platelet medications. CONCLUSION: Diagnosis of limb-shaking TIA is important and should be differentiated from other disorders presenting as tremors. Timely diagnosis is important as these patients are shown to benefit from reperfusion procedures either surgical or radiological reducing their risk of stroke

Vertebral Artery Dissecting Aneurysm Treated by Proximal Occlusion and Posterior Inferior Cerebellar Artery Reconstruction With Fenestrated Clips -Case Report-

A 57-year-old man presented with subarachnoid hemorrhage caused by a dissecting aneurysm of the vertebral artery close to the origin of the posterior inferior cerebellar artery (PICA). The aneurysm was treated successfully with two fenestrated clips preserving the efferent artery with anterograde blood flow without PICA anastomosis. The postoperative course was uneventful. Postoperative angiography indicated disappearance of the aneurysm and anterograde blood flow of the PICA.ArticleNEUROLOGIA MEDICO-CHIRURGICA. 50(8):655-658 (2010)journal articl