4.4 Article

A case of limb shaking transient ischaemic attack due to internal carotid artery dissection: an unusual presentation of fibromuscular dysplasia

Journal

BMC NEUROLOGY
Volume 23, Issue 1, Pages -

Publisher

BMC
DOI: 10.1186/s12883-023-03130-9

Keywords

Limb shaking TIA; Stroke; Fibromuscular dysplasia; Dissection; Carotid artery

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A 47-year-old Asian female presented with intermittent involuntary movement of the left upper limb accompanied by neck torsion. Further imaging showed an intravascular hematoma with irregular lumen stenosis, indicating carotid artery dissection. The patient was diagnosed with limb shaking TIA due to internal carotid dissection with fibromuscular dysplasia. The symptoms resolved and did not recur during the three-month follow-up.
BackgroundFibromuscular dysplasia (FMD) has a high prevalence of associated nontraumatic carotid artery dissection, which could further result in transient ischaemic attack (TIA) or stroke. Limb shaking TIA is an unusual form of TIA that is commonly discribed in elderly patients with atherosclerotic backgrounds, while there are limited data about it in patients with FMD. Furthermore, discussions of limb shaking TIA in nonelderly patients are scarce.Case presentationAn Asian 47-year-old female presented with intermittent involuntary movement of the left upper limb accompanied by neck torsion. The episode stopped soon after changing to the supine position. On native source images of time-of-flight magnetic resonance angiography (TOF-MRA), the right internal carotid artery showed a dual lumen sign with an intimal flap. On contrast-enhanced magnetic resonance angiography and sagittal black-blood T1WI, an intravascular haematoma with irregular lumen stenosis was observed, which overall indicated right internal carotid artery dissection. Digital subtraction angiography showed the characteristic string-of-beads appearance in the left internal carotid artery, and the presence of this sign pointed to the diagnosis of FMD. The patient was finally diagnosed with limb shaking TIA due to internal carotid dissection with fibromuscular dysplasia. The patient was prescribed dual anti-platelet therapy. The limb shaking vanished soon after admission with no reoccurrence in the three-month follow-up.ConclusionsThis case demonstrates that limb shaking TIA can present in patients with FMD. Limb shaking TIA in nonelderly patients can be caused by multiple diseases, and more detailed patient guidance is required in clinical practice.

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