Alonso Joaquin Valle, del Pozo Francisco Javier Fonseca, Simón Jesús Carmona, Valenzuela Saray, Perez Gomez Francisca, Lopera Elisa
Department of Accident and Emergency Medicine, Southport and Ormskirk, NHS Trust, Southport, UK.
Department of Critical Care and Emergency Medicine, Ambulance service, Montoro, Córdoba, Spain.
J Stroke Cerebrovasc Dis. 2015 Nov;24(11):e327-31. doi: 10.1016/j.jstrokecerebrovasdis.2015.07.006. Epub 2015 Aug 30.
demonstrate the importance of considering limb-shaking syndrome in the differential diagnosis of patients who present to the emergency department (ED) with hyperkinetic movements.
In this article, we describe a diagnostic challenge in the ED in which a patient presents with hyperkinetic movements that are initially diagnosed as hemichorea-hemiballismus (HCHB) but are subsequently found to be limb-shaking syndrome with important therapeutic opportunities.
Following a diagnosis of left carotid obstruction, the patient underwent left carotid endarterectomy 5 days after admission. Six months after surgery, the patient had no further symptoms, and an ultrasound scan and magnetic resonance angiography have confirmed no restenosis.
Limb shaking is an uncommon form of transient ischemic attack that should be recognized and differentiated from conditions such as focal motor seizures. Recognition will almost invariably indicate carotid artery occlusion, and timely treatment may not only abolish the attacks in patients but also reduce their risk of stroke. HCHB represents a spectrum of hyperkinetic movement disorders varying in the severity of choreic and/or ballistic movements. The presented case includes limb-shaking syndrome in the differential diagnosis and prompts for further investigations to complete the assessment.
证明在对急诊科（ED）出现运动亢进的患者进行鉴别诊断时考虑肢体抖动综合征的重要性。
在本文中，我们描述了急诊科的一个诊断难题，即一名患者出现运动亢进，最初被诊断为偏身舞蹈症 - 偏身投掷症（HCHB），但随后被发现是具有重要治疗机会的肢体抖动综合征。
在诊断为左颈动脉阻塞后，患者入院5天后接受了左颈动脉内膜切除术。术后6个月，患者无进一步症状，超声扫描和磁共振血管造影证实无再狭窄。
肢体抖动是短暂性脑缺血发作的一种不常见形式，应予以识别并与局灶性运动性癫痫等疾病相鉴别。识别几乎总是提示颈动脉闭塞，及时治疗不仅可以消除患者的发作，还可以降低他们的中风风险。HCHB代表了一系列运动亢进性运动障碍，其舞蹈样和/或投掷样运动的严重程度各不相同。所呈现的病例在鉴别诊断中包括肢体抖动综合征，并促使进行进一步检查以完成评估。
