Bilateral asymmetrical asterixis as limb-shaking transient ischemic attack in bilateral carotid stenosis

J Stroke Cerebrovasc Dis. 2015 Jan;24(1):e29-30. doi: 10.1016/j.jstrokecerebrovasdis.2014.08.016. Epub 2014 Nov 8.

Abstract

Asterixis as limb-shaking transient ischemic attack (TIA) is rare and poorly understood. Bilateral asymmetrical asterixis as limb-shaking TIA has not been reported in carotid stenosis. A 69-year-old gentleman presented with a TIA episode (dysarthria, right-arm weakness, and numbness). Bilateral asterixis was observed and was more severe on the right side. No prior infarcts were noted in the thalamus. Liver function was normal. A computerized tomography angiogram revealed 85%stenosis of the right internal carotid artery (ICA) and 65% stenosis of the left ICA. Three days after left ICA endarterectomy, the patient had complete disappearance of bilateral asterixis, with the right side showing initial improvement. The bilateral asterixis observed is proposed to be secondary to hemodynamic impairment and hypoperfusion of certain brain territory with resolution on revascularization.

Keywords: Carotid stenosis; asterixis; carotid endarterectomy; limb shaking TIA.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Angiography
  • Carotid Artery, Internal / diagnostic imaging*
  • Carotid Artery, Internal / surgery
  • Carotid Stenosis / complications*
  • Carotid Stenosis / diagnostic imaging
  • Carotid Stenosis / surgery
  • Dyskinesias / diagnostic imaging
  • Dyskinesias / etiology*
  • Dyskinesias / surgery
  • Endarterectomy, Carotid
  • Humans
  • Ischemic Attack, Transient / complications*
  • Ischemic Attack, Transient / diagnostic imaging
  • Ischemic Attack, Transient / surgery
  • Male
  • Treatment Outcome