Crisis focal motora sin alteración de conciencia secundaria a accidente cerebrovascular. Reporte de un caso y diagnóstico diferencial con Limb Shaking

Introducción: Si bien la primera causa de crisis epilépticas en la población adulta mayor es el accidente cerebrovascular, un importante diagnóstico diferencial corresponde al limb shaking syndrome, una manifestación clínica particular de un accidente isquémico transitorio. Caso clínico: Se describe entonces el caso de un hombre chileno de 62 años de edad que sufre una crisis focal motora sin alteración de conciencia con evidencia imagenológica de injuria isquémica de unos 10 días de antigüedad y de estenosis carotídea significativa, la cual es manejada quirúrgicamente. Discusión: Existen diferentes elementos que pueden distinguir una crisis epiléptica de un limb shaking sryndrome. La fisiopatología de la primera corresponde un fenómeno irritativo post isquémico con una clara manifestación electroencefalográfica, mientras que la segunda es producida por hipoperfusión relativa gatillada por ortostatismo en el contexto de una enfermedad carotídea oclusiva. El cuadro clínico del paciente se consideró más compatible con una crisis epiléptica que con un limb shaking syndrome.

Introduction: Although the leading cause of seizures in the older adult population is cerebrovascular accident, limb shaking syndrome is an important differential diagnosis, being a particular clinical manifestation of a transient ischemic attack. Clinical case: We thus describe a clinical case of a 62-year-old Chilean man who suffers a simple focal motor epileptic seizure, with imaging evidence of ischemic injury about 10 days old and significant carotid stenosis which is managed surgically. Discussion: There are different elements that can distinguish an epileptic seizure from a limb shaking syndrome. The pathophysiology of the first corresponds to a post-ischemic irritative phenomenon with a clear electroencephalographic manifestation, while the second is produced by relative hypoperfusion triggered by orthostatism in the context of carotid occlusive disease. The patient's clinical picture was considered more compatible with an epileptic seizure than with a limb shaking syndrome syndrome.

Recent advance in clinical problems of limb-shaking transient ischemic attack / 中华神经医学杂志

Limb shaking transient ischemic attack (LS-TIA) is a rare form of TIA, usually based on severe narrowing or occlusion of the internal carotid artery. Clinically, it is mainly characterized by episodic involuntary limb shaking, which generally lasts for several seconds or minutes and often occurs after exercise or standing up. At present, there are few studies on LS-TIA in China, with only sporadic case reports, and without systematic review and meta-analysis studies; and it seems to fail in attracting widespread concern from neurologists. In this paper, the pathogenesis, clinical features, imaging features and diagnosis and treatment methods of LS-TIA are reviewed as follows, in order to improve the level of early recognition and treatment of LS-TIA from clinicians.

The clinical characteristics of limb-shaking transient ischemic attack / 中国医师进修杂志

Limb shaking transient ischemic attack (LS-TIA) can be recognized by paroxysmal cerebral hemisphere hemodynamic damage performance that lasts for several seconds or minutes, often occurring after exercise or standing and may be accompanied by numbness of the local limb. Clinically LS-TIA is ignored by doctors and misdiagnosed as epilepsy and the disease has a high risk of stroke and poor prognosis. The prompt recognition of the limb-shaking transcient ischemic attack is crucial to implement options aiming at preventing future stroke. Patients with LS-TIA can benefit from therapies aiming at improving cerebral perfusion.However, the benefit of revascularization and drug conservative treatment remains to be determined and specific diagnosis and treatment should be formulated according to the specific clinical characteristics of patients.

Limb-Shaking Transient Ischemic Attack due to Stenosis of the Middle Cerebral Artery: Case Report

We present a case of a 51-year-old man with frequent left limb-shaking transient ischemic attacks due to severe stenosis of the right proximal middle cerebral artery(MCA). The involuntary movement was provoked by walking and it was relieved by adopting a squatting posture. Initially, we tried antiepileptic medication, but it did not eliminate the involuntary movement. Cerebral angiography and single photon emission computed tomography demonstrated decreased perfusion and reserve capacity of the right cerebral hemisphere which correspond to stenotic proximal MCA territory. After superficial temporal artery to MCA anastomosis, the decreased reserve capacity was restored and his limb-shaking attack completely disappeared. His history of radiotherapy for craniopharyngioma, in addition to hypercholesterolemia and diabetes mellitus, seems to have contributed to gradual stenosis of right MCA.