Farooqui Naba, Williams Andrew, Webb Lauren M, Motiei Arashk, Scharf Eugene L
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
JACC Case Rep. 2025 Jun 11;30(14):103635. doi: 10.1016/j.jaccas.2025.103635.
Limb-shaking transient ischemic attacks represent an atypical presentation of transient ischemic attacks usually seen with carotid artery stenosis but may occur in severe brachiocephalic stenosis.
We present the case of a 67-year-old woman with severe brachiocephalic artery stenosis but no significant right carotid disease with a 2-year history of alternating movements of the left upper and lower limbs with postural changes culminating in a large-vessel stroke, with resolution of the alternating movements after a left-to-right subclavian bypass.
Only 4 cases of limb-shaking transient ischemic attacks secondary to subclavian/brachiocephalic artery stenosis have been described in literature. Cardiologists often see these patients in the vascular clinic. If recognition of these shaking movements in the context of transient ischemic attacks is missed, it can lead to a delay in appropriate intervention, thereby increasing the future risk of stroke.
TAKE-HOME MESSAGES: Proximal vessel stenosis can lead to TIAs. Timely recognition and early intervention (preferably surgical) in cases of brachiocephalic/subclavian stenosis with LSTIAs is important as it can be crucial for stroke prevention.
肢体抖动性短暂性脑缺血发作是短暂性脑缺血发作的一种非典型表现，通常见于颈动脉狭窄，但也可能发生在严重的头臂干狭窄时。
我们报告一例67岁女性，患有严重的头臂干动脉狭窄，但右侧颈动脉无明显病变，有2年病史，即随着体位改变，左上肢和下肢交替运动，最终导致大血管性卒中，在进行左向右锁骨下动脉搭桥术后，交替运动消失。
文献中仅描述了4例继发于锁骨下动脉/头臂干动脉狭窄的肢体抖动性短暂性脑缺血发作病例。心脏病专家常在血管门诊见到这些患者。如果在短暂性脑缺血发作的背景下未识别出这些抖动运动，可能会导致适当干预延迟，从而增加未来卒中风险。
近端血管狭窄可导致短暂性脑缺血发作。对于伴有肢体抖动性短暂性脑缺血发作的头臂干/锁骨下动脉狭窄病例，及时识别并早期干预（最好是手术干预）很重要，因为这对预防卒中可能至关重要。
