Abstract 126: Bilateral Limb Shaking TIA secondary to Severe Bilateral Carotid Stenosis

• DOI: 10.1161/svin.03.suppl_2.126
• Publication Date: 2024-03-05T09:29:14Z
• Authors: Muhannad Seyam; Michael Hehir; Fatemeh Sobhani
• Keywords: RC666-701; Diseases of the circulatory (Cardiovascular) system; Neurology. Diseases of the nervous system; RC346-429

Introduction A case describing bilateral limb shaking episodes in a patient with severe carotid disease ‐ rare manifestation of limb‐shaking TIA. Methods '‐ Results CASE 71‐year‐old male past medical history significant for type 2 diabetes mellitus and carpal tunnel syndrome is being followed symptomatic management known axonal sensorimotor diabetic polyneuropathy the neuromuscular clinic. He reported on one his follow‐up visits that he had been experiencing an eight‐month presyncopal to syncopal events occurring solely standing position, not by postictal state but amnesia syncope itself, resulting falls mild injuries. was new‐onset dry eyes mouth denied anhidrosis or early satiety, cardiac event monitoring during these unremarkable rhythmic causes. Examination unchanged from previously findings consistent length‐dependent sensory loss hyporeflexia/areflexia. The constellation symptoms suggestive autonomic dysfunction, while this may be seen polyneuropathy, workup alternative neuropathies (including SSA/SSB antibodies, paraneoplastic antibody panel, serum protein electrophoresis immunofixation, free light chains, transthyretin amyloid) obtained plan follow‐up. few months later, presented ED intermittent upper extremity (more pronounced right than left) preceding events, which only occurred position physical activity resolved rest. There were no (transient) focal neurological deficits, including monocular vision hemispheric syndrome. CTA head/neck notable critical stenoses internal arteries (see figure 1). Duplex US revealed 80‐99% stenosis both left proximal arteries. most TIA secondary stenosis. started stroke prevention referred vascular surgery evaluation revascularization. underwent endarterectomy briefly afterward experienced resolution – later also side remains asymptomatic. DISCUSSION: Limb‐shaking well‐described yet underrecognized C.M. Fisher 1962. “limb shaking” are typically unilateral, affecting arm leg, often mistaken seizures [1]. Pathogenesis involves hemodynamic impairment related extracranial/intracranial occlusion stereotypical recurrent contralateral precipitated [2], [3]. spells upon after cessation should raise suspicion warrant imaging. Treatment includes revascularization procedures [4], can alleviate even resolve transient [2]. Conclusion important relative cerebral hypoperfusion cerebrovascular disease. This describes