Differential diagnosis of focal onset seizure limb-shaking transient ischemic attaks

Abstract

Limb-shaking transient ischemic attack (TIA); is an uncontrolled rhythmic or dysrhythmic, temporary, and generally coarse tremor movement of the upper or lower extremities. Since Miller Fisher’s first report of limb-shaking TIA associated with internal carotid artery (ICA) stenosis in 1962, this condition has been described regularly. These are characterized by brief, arrhythmic, jagged, or jerky movements of the extremities and are generally misdiagnosed as focal seizures or movement disorders. TIA is usually correlated with negative neurological symptoms; thus, the diagnosis of TIA is typically not considered in patients presenting with episodic abnormal movement disorder. We presented three cases, one of these cases was one with ICA stenosis who benefits from revascularizatıon treatment (internal carotid artery stenting), the second case with ICA stenosis and who does not benefit from revascularization treatment (carotid endarterectomy operation), and the last patient wıthout ICA stenosis. The common feature of all three patients was hypotension. These patients are not as rare as thought, and the etiology of cerebral hypoperfusion should be urgently evaluated.