A Less Frequent Etiology of Limb Shaking Syndrome: A Severe Middle Cerebral Artery Stenosis

Abstract

Background: Limb Shaking Syndrome (LSS) is usually associated with internal carotid occlusion. There are few reported-cases in context of middle cerebral artery stenosis.

Methods: We presented LSS in a patient with middle cerebral artery stenosis disease.

Results: The patient was a 62-year-old man, smoker, with high blood pressure who suffered left hemifacial and limbs myoclonus. He was initially diagnosed with focal seizures and he started antiepileptic treatment. However, he repeated the episodes. The electroencephalogram showed no abnormalities, and a vascular study with ultrasounds and angio-MRI evidenced severe middle cerebral stenosis. Finally, a diagnosis of Limb Shaking Syndrome was established and he started antiplatelet and high dose lipid-lowering treatment.

Conclusion: Not all abnormal movements are due to epileptic seizures. When we evaluate a patient with vascular risk factors it is important to perform a complete vascular study to discard not only critical carotid stenosis but also intracranial disease.

Keywords: Focal seizures; Intracranial stenosis; Limb Shaking Syndrome; Transient ischemic attack.