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London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 369 164 Interesting and challenging cases Bilateral Asynchronous Transient Limb Shaking due to Bilateral Carotid Occlusion V.K. Sharma1, P.R. Paliwal2, H.L. Teoh3, R.C. Seet4, L.L. Yeo5, B.P.L. Chan6 National University of Singapore, Singapore, SINGAPORE1, National University Health System, Singapore, SINGAPORE2, National University Health System, Singapore, SINGAPORE3, National University of Singapore, Singapore, SINGAPORE4, National University Health System, Singapore, SINGAPORE5, National University Health System, Singapore, SINGAPORE6 Background and aim- Transient unilateral limb shaking is a known manifestation of reduced cere-bral perfusion due to severe steno-occlusive disease of internal carotid artery (ICA). We describe a case of bilateral transient limb shaking in a patient with bilateral ICA occlusion. Case Description- A 81-year old hypertensive female presented with sudden-onset of left-sided weakness. She was suffering from gastroenteritis for past 2 days. On examination, she was mild-ly dehydrated, drowsy with blood pressure (BP) 107/63mmHg and left hemiparesis (power grade 2, NIHSS 14 points). She was having involuntary jerking of both sides, occurring independently. Movements were aggravated in sitting position (with no postural BP drop) and during sleep. Mag-netic resonance imaging (MRI) of brain showed acute infarcts in right lentiform nucleus, corona ra-diata and deep watershed areas of right cerebral hemisphere. Old infarcts were seen in both internal watershed regions. MR angiography and cervical duplex sonography showed complete occlusion of both ICAs in the neck. Electroencephalography showed mild diffuse bilateral slowing without any epileptiform activity. Transcranial Doppler (TCD) showed blunted flow in both middle cerebral ar-teries (MCA) and 30% reduction in flow velocities upon assuming sitting position. Her BP medica-tions were stopped and she was treated with generous intravenous fluids, nasal oxygen (despite nor-mal blood gasses and oxygen saturation) and kept in ‘lying flat’ position most of the time. Her level of consciousness and limb shaking improved gradually and she tolerated prolonged sitting by day-6. With gentle rehabilitation, she could walk with assistance by 3-months. Conclusions- Patients with transient limb shaking, especially when orthostatic, should be evaluated for hemodynamically significant steno-occlusive disease of the carotid arteries. Timely diagnosis and appropriate therapeutic measures may help in preventing early clinical worsening and recur-rence.


Karger_ESC London_2013
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