Limb Shaking Transient Ischemic Attacks with Normal Neurovascular Ultrasound may Herald Cardioembolic Stroke: A Case Report

Our objective is to highlight that the rare occurrence of limb shaking in transient ischemic attacks may be underpinned by etiologies other than critical internal carotid stenosis/occlusion. We describe a 74 year-old woman with abrupt left arm jerking and normal urgent computed tomography scan, electroencephalography (EEG) as well as carotid and transcranial ultrasound. Two days later she developed an overt ischemic stroke, with left mesencephalon and left cerebellar hemisphere lesions at brain magnetic resonance imaging and paroxysmal atrial fibrillation at Holter-EKG. Transient ischemic attacks should be considered in the differential diagnosis of limb shaking even in patients with normal carotid and transcranial ultrasonography.