1
|
Pitton Rissardo J, Fornari Caprara AL. Limb-Shaking And Transient Ischemic Attack: A Systematic Review. Neurologist 2024; 29:126-132. [PMID: 37839077 DOI: 10.1097/nrl.0000000000000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND Limb-shaking is one of the transient ischemic attacks (TIA) 'chameleons.' This literature review aims to evaluate the clinical, epidemiological profile, pathologic mechanisms, and management of limb-shaking TIA. REVIEW SUMMARY Relevant reports in Medline's (PubMed) database were identified and assessed by 2 reviewers without language restriction from 1985 to 2022. A total of 82 reports containing 161 cases that developed limb-shaking TIA were reported. The mean and median age were 61.36 (SD: 15.29) and 62 years (range: 4-93 y). Most of the individuals affected were males (64.34%). Limb-shaking was reported as unilateral in 83.33% of the patients. Limb-shaking presented with other neurological deficits in 44.33% of the individuals, in which the most common concurrent neurological deficit was the weakness of at least 1 limb. A recurrence of the "shaking" phenomenon was observed in 83 individuals. A trigger of limb-shaking was reported in 69 cases, and the most common was changing body position. The internal carotid artery was the most frequent vessel involved in limb-shaking. A chronically occluded internal carotid artery was observed in 42 individuals. Hypertension was the most common comorbidity. The management was conservative in 42.30% of the cases. The most frequent misdiagnoses were seizures. A full recovery was achieved in 56.60% of the individuals. CONCLUSIONS Limb-shaking TIA could be defined as involuntary, rhythmic, brief (<5 min), recurrent, jerky movement usually precipitated by activities that may reduce cerebral blood flow. The "shaking" phenomenon was primarily described as a manifestation of symptomatic complete internal carotid artery obstruction.
Collapse
|
2
|
Darıcı D, Gönül Öner Ö, Ertürk Çetin Ö, Zanapalıoğlu Ü, Önal Y, Karadeli HH. Limb-shaking transient ischemic attack misdiagnosed as focal seizure: A video case report. Epileptic Disord 2023; 25:567-570. [PMID: 36938896 DOI: 10.1002/epd2.20041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/21/2023]
Abstract
Content available: Video
Collapse
Affiliation(s)
- Didem Darıcı
- Department of Neurology, Istanbul Medeniyet University Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Özge Gönül Öner
- Department of Neurology, Istanbul Medeniyet University Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Özdem Ertürk Çetin
- Department of Neurology, Sancaktepe Sehit Prof. Dr. İlhan Varank Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ümit Zanapalıoğlu
- Department of Neurology, Sancaktepe Sehit Prof. Dr. İlhan Varank Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yılmaz Önal
- Interventional Radiology Department, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Hasan Hüseyin Karadeli
- Department of Neurology, Istanbul Medeniyet University Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| |
Collapse
|
3
|
Shimizu T, Haro K, Tagawa M, Hirata M, Iwano S, Kosaka H, Yamamoto Y. Bilateral ballism as limb-shaking transient ischemic attacks treated with unilateral carotid artery stent placement. J Stroke Cerebrovasc Dis 2022; 31:106781. [PMID: 36156444 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/07/2022] [Accepted: 09/10/2022] [Indexed: 10/31/2022] Open
Abstract
Bilateral limb-shaking transient ischemic attack (LS-TIA) is a rare disease involving carotid artery stenosis, characterized by ballism-like involuntary movements of the arms and legs. We describe the case report of a male patient in his 80s presented with continuous bilateral ballism in the arms and legs and tongue dyskinesia. Magnetic resonance imaging showed no ischemic lesions, while cerebral angiography revealed right internal carotid artery (ICA) occlusion and 80% stenosis of the left ICA. 99mTc-ethyl cysteinate dimer single-photon emission computed tomography demonstrated hypoperfusion in the right cerebral cortex but hyperperfusion in both basal ganglia. Left ICA stenting was performed, and involuntary limb shaking disappeared. This case report highlights the importance of accurate diagnosis and treatment of bilateral ballism as LS-TIA.
Collapse
Affiliation(s)
- Toshihiko Shimizu
- Department of Neurosurgery, Matsuyama Shimin Hospital, Matsuyama City, Ehime, Japan.
| | - Keiko Haro
- Department of Neurology, Matsuyama Shimin Hospital, Matsuyama City, Ehime, Japan
| | - Masahiko Tagawa
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Tōon City, Ehime, Japan
| | - Masaaki Hirata
- Department of Radiology, Matsuyama Shimin Hospital, Matsuyama City, Ehime, Japan
| | - Sachiko Iwano
- Department of Radiology, Matsuyama Shimin Hospital, Matsuyama City, Ehime, Japan
| | - Hiroshi Kosaka
- Department of Neurosurgery, Matsuyama Shimin Hospital, Matsuyama City, Ehime, Japan
| | - Yuji Yamamoto
- Department of Neurosurgery, Matsuyama Shimin Hospital, Matsuyama City, Ehime, Japan
| |
Collapse
|
4
|
Park KW, Choi N, Oh E, Lyoo CH, Baek MS, Kim HJ, Yoo D, Lee JY, Choi JH, Lee JH, Koh SB, Sung YH, Cho JW, Yang HJ, Park J, Shin HW, Ahn TB, Ryu HS, You S, Choi SM, Kim BJ, Lee SH, Chung SJ. Movement Disorders Associated With Cerebral Artery Stenosis: A Nationwide Study. Front Neurol 2022; 13:939823. [PMID: 35911886 PMCID: PMC9330487 DOI: 10.3389/fneur.2022.939823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022] Open
Abstract
Background Studies of secondary movement disorder (MD) caused by cerebrovascular diseases have primarily focused on post-stroke MD. However, MD can also result from cerebral artery stenosis (CAS) without clinical manifestations of stroke. In this study, we aimed to investigate the clinical characteristics of MD associated with CAS. Materials and Methods A nationwide multicenter retrospective analysis was performed based on the data from patients with CAS-associated MDs from 16 MD specialized clinics in South Korea, available between January 1999 and September 2019. CAS was defined as the >50% luminal stenosis of the major cerebral arteries. The association between MD and CAS was determined by MD specialists using pre-defined clinical criteria. The collected clinical information included baseline demographics, features of MD, characteristics of CAS, treatment, and MD outcomes. Statistical analyses were performed to identify factors associated with the MD outcomes. Results The data from a total of 81 patients with CAS-associated MD were analyzed. The mean age of MD onset was 60.5 ± 19.7 years. Chorea was the most common MD (57%), followed by tremor/limb-shaking, myoclonus, and dystonia. Atherosclerosis was the most common etiology of CAS (78%), with the remaining cases attributed to moyamoya disease (MMD). Relative to patients with atherosclerosis, those with MMD developed MD at a younger age (p < 0.001) and had a more chronic mode of onset (p = 0.001) and less acute ischemic lesion (p = 0.021). Eight patients who underwent surgical treatment for CAS showed positive outcomes. Patients with acute MD onset had a better outcome than those with subacute-to-chronic MD onset (p = 0.008). Conclusions This study highlights the spectrum of CAS-associated with MD across the country. A progressive, age-dependent functional neuronal modulation in the basal ganglia due to CAS may underlie this condition.
Collapse
Affiliation(s)
- Kye Won Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, South Korea
| | - Nari Choi
- Department of Neurology, Heavenly Hospital, Goyang, South Korea
| | - Eungseok Oh
- Department of Neurology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Seok Baek
- Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Han-Joon Kim
- Department of Neurology, Movement Disorder Center, College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Dalla Yoo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center and Seoul National University Medical College, Seoul, South Korea
| | - Ji-Hyun Choi
- Department of Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center and Seoul National University Medical College, Seoul, South Korea
| | - Jae Hyeok Lee
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University College of Medicine, Guro Hospital, Seoul, South Korea
| | - Young Hee Sung
- Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hui-Jun Yang
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jinse Park
- Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, South Korea
| | - Hae-Won Shin
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Tae-Beom Ahn
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Ho-Sung Ryu
- Department of Neurology, Kyungpook National University Hospital, Daegu, South Korea
| | - Sooyeoun You
- Department of Neurology, Dongsan Medical Center, Keimyung University, Daegu, South Korea
| | - Seong-Min Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung Hyun Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- *Correspondence: Sun Ju Chung
| |
Collapse
|
5
|
Tan CHN, Taneja M, Venketasubramanian N. Limb-Shaking Transient Ischemic Attacks in a Patient with Previous Bilateral Neck Irradiation: The Role of Collateral Flow. Case Rep Neurol 2020; 12:84-90. [PMID: 33505277 PMCID: PMC7802474 DOI: 10.1159/000505391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/11/2019] [Indexed: 10/17/2023] Open
Abstract
Nasopharyngeal carcinoma (NPC) is commonly treated with bilateral neck radiation, which is closely associated with the complication of carotid-occlusive disease. This leads to cerebral hemodynamic compromise and possible ischemic stroke. Another manifestation is limb-shaking transient ischemic attacks (LS-TIAs), characterized by rhythmic jerks which can be easily mistaken as a focal motor seizure. We describe a case of unilateral LS-TIAs from bilateral carotid occlusion that resolved with contralateral carotid revascularization. Our patient is a 65-year-old gentleman who had no significant co-morbidities other than a past history of bilateral neck irradiation for NPC 8 years before. He presented with left-sided limb weakness and subsequently left-sided limb involuntary movements whenever he sat up or stood. His symptoms did not respond to anti-epileptic therapy. Clinical and neurological examination was significant for a left pronator drift and weak left finger abduction. Computed tomography and magnetic resonance imaging of the brain revealed infarcts in the right periventricular and watershed areas; MR angiogram showed bilateral internal carotid artery occlusion. Single photon emission computed tomography showed reduced blood flow in the right frontal, temporal, and parietal regions, that reduced further after acetazolamide challenge. He was diagnosed as having LS-TIA secondary to carotid-occlusive disease. Attempts at endovascular opening the right internal carotid artery failed. Following successful left carotid angioplasty and stenting, his symptoms gradually resolved. The left internal carotid artery remained patent at the 3-month follow-up; the right side remained occluded. Our case supports the hypothesis that LS-TIAs are due to hemodynamic compromise and may respond to improved collateral cerebral blood flow.
Collapse
Affiliation(s)
- Chai-Hoon Nowel Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Manish Taneja
- Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
| | | |
Collapse
|
6
|
Hebant B, Guyant-Marechal L, Maltête D, Lefaucheur R. Acute hemichorea revealing atrial flutter. J Postgrad Med 2018; 65:248616. [PMID: 30588926 PMCID: PMC6380122 DOI: 10.4103/jpgm.jpgm_448_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 10/15/2018] [Accepted: 11/05/2018] [Indexed: 11/24/2022] Open
Abstract
Transient ischemic attacks (TIAs) typically present with easily recognizable neurological focal deficits. Symptoms such as paroxysmal involuntary movements are not usually considered to be a manifestation of TIA. We report a case with video documentation of TIA due to permanent atrial flutter presenting as acute left hemichorea. To our knowledge, such a case has not yet been reported. The present case constitutes a crucial diagnostic challenge in neurological practice in order to prevent a high risk of subsequent ischemic stroke.
Collapse
Affiliation(s)
- B Hebant
- Department of Neurology, Rouen University Hospital, France
| | | | - D Maltête
- Department of Neurology, Rouen University Hospital, France
- Inserm U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, University of Rouen, France
| | - R Lefaucheur
- Department of Neurology, Rouen University Hospital, France
| |
Collapse
|
7
|
Hextrum S, Biller J. Clinical Distinction of Cerebral Ischemia and Triaging of Patients in the Emergency Department. Neuroimaging Clin N Am 2018; 28:537-549. [DOI: 10.1016/j.nic.2018.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
8
|
Bartolini E, Napolitano A, Mazzoni M. Limb Shaking Transient Ischemic Attacks with Normal Neurovascular Ultrasound may Herald Cardioembolic Stroke: A Case Report. J Stroke Cerebrovasc Dis 2018; 27:e228-e229. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/22/2018] [Indexed: 11/28/2022] Open
|
9
|
Obayashi T, Takeda T, Iijima M, Shimizu Y, Yoshizawa H, Kitagawa K. Unilateral flapping tremor associated with internal carotid artery stenosis. Eur J Neurol 2018; 25:e56-e57. [DOI: 10.1111/ene.13604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 02/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- T. Obayashi
- Department of Neurology; Tokyo Women' Medical University; Tokyo Japan
| | - T. Takeda
- Department of Neurology; Tokyo Women' Medical University; Tokyo Japan
| | - M. Iijima
- Department of Neurology; Tokyo Women' Medical University; Tokyo Japan
| | - Y. Shimizu
- Department of Neurology; Tokyo Women' Medical University; Tokyo Japan
| | - H. Yoshizawa
- Department of Neurology; Tokyo Women' Medical University; Tokyo Japan
| | - K. Kitagawa
- Department of Neurology; Tokyo Women' Medical University; Tokyo Japan
| |
Collapse
|
10
|
Feil K, Huber M, Goldschagg N, Kellert L. Unilateral Asterixis in Arm and Leg Caused by Internal Capsula Stroke. Case Rep Neurol Med 2018; 2018:1-3. [PMID: 29593921 PMCID: PMC5822760 DOI: 10.1155/2018/3946380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/25/2017] [Indexed: 11/18/2022] Open
Abstract
We report an unusual clinical manifestation of ischemic stroke with acute right-sided asterixis affecting the arm as well as the leg due to a lesion in the left posterior limb of the internal capsula. After treatment with intravenous thrombolysis the patient made a good recovery. Notably, in this case unilateral asterixis affected the arm as well as the leg, resulting in postural and gait instability. In addition, damage in the basal ganglia-thalamo-cortical network, as in our patient, has to be distinguished from other supratentorial causes of acute asterixis like thalamic or frontal lobe lesions linked to the cerebello-brainstem-thalamo-frontal lobe circuits.
Collapse
|
11
|
Abstract
Tremor is a common neurological condition in clinical practice; yet, few syndromes are widely recognised and discussed in the literature. As a result, there is an overdiagnosis of well-known causes, such as essential tremor. Many important unusual syndromes should be considered in the differential diagnosis of patients with tremor. The objective of this review is to provide broad clinical information to aid in the recognition and treatment of various unusual tremor syndromes in the adult and paediatric populations. The review comprised of a comprehensive online search using PubMed, Ovid database and Google Scholar to identify the available literature for each unusual tremor syndrome. The review includes fragile X-associated tremor/ataxia syndrome, spinocerebellar ataxia type 12, tremors caused by autosomal recessive cerebellar ataxias, myorhythmia, isolated tongue tremor, Wilson's disease, slow orthostatic tremor, peripheral trauma-induced tremor, tardive tremor and rabbit syndrome, paroxysmal tremors (hereditary chin tremor, bilateral high-frequency synchronous discharges, head tremor, limb-shaking transient ischaemic attack), bobble-head doll syndrome, spasmus nutans and shuddering attacks. Rare tremors generally present with an action tremor and a variable combination of postural and kinetic components with resting tremors less frequently seen. The phenomenology of myorhythmia is still vague and a clinical definition is proposed. The recognition of these entities should facilitate the correct diagnosis and guide the physician to a prompt intervention.
Collapse
Affiliation(s)
- Robert J Ure
- Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Sanveer Dhanju
- Faculty of Science, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Anthony E Lang
- Division of Neurology, Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Division of Neurology, Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
12
|
Joseph JR, Delavari N, Wilkinson DA, Roark C, Thompson BG. A Case of Complete Resolution of Hemiballismus After Carotid Endarterectomy. World Neurosurg 2016; 95:624.e5-624.e7. [DOI: 10.1016/j.wneu.2016.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 11/26/2022]
|
13
|
Gasca-Salas C, Lang AE. Paroxysmal Hemiballism/Hemichorea Resulting from Transient Ischemic Attacks. Mov Disord Clin Pract 2015; 3:303-305. [PMID: 30713922 DOI: 10.1002/mdc3.12268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/31/2015] [Accepted: 09/05/2015] [Indexed: 11/09/2022] Open
Affiliation(s)
- Carmen Gasca-Salas
- Toronto Western Hospital Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease Toronto Ontario Canada
| | - Anthony E Lang
- Toronto Western Hospital Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease Toronto Ontario Canada
| |
Collapse
|
14
|
Swinnen B, Schreurs A, Heye S, Lemmens R. Limb-shaking TIA during balloon test occlusion of the internal carotid artery. Acta Neurol Belg 2015; 115:449-51. [PMID: 25283769 DOI: 10.1007/s13760-014-0366-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/18/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Bart Swinnen
- Department of Neurology, University Hospitals Leuven, University of Leuven and VIB, Herestraat 49, 3000, Leuven, Belgium
| | | | | | | |
Collapse
|
15
|
Affiliation(s)
- Edward T Littleton
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Nicholas Glover
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Alok Tiwari
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| |
Collapse
|
16
|
Khan S, Chang E, Saniuk G, Shang T. Bilateral Asymmetrical Asterixis as Limb-shaking Transient Ischemic Attack in Bilateral Carotid Stenosis. J Stroke Cerebrovasc Dis 2015; 24:e29-30. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/14/2014] [Accepted: 08/18/2014] [Indexed: 11/22/2022] Open
|