Limb-shaking TIA in Moyamoya angiopathy

Das, Shambaditya; Ghosh, Ritwik; Dubey, Souvik; Pandit, Alak; Ray, Biman Kanti; Kraemer, Markus

doi:10.1016/j.clineuro.2021.106783

Cited by 18 publications

(17 citation statements)

References 16 publications

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“…Moyamoya disease was the most widely investigated vasculopathy in nonelderly patients with limb shaking TIA [ 3 , 6 ], which was highly in accordance with the age distribution of Moyamoya disease [ 3 ]. The published triggers were mostly in coincidence with those in elderly patients, such as exercise and hyperventilation, while some unique triggers were reported, such as eating hot spicy food, singing, sneezing, prolonged crying, emotional stress, and smoking [ 3 ]. Compared to limb shaking TIA patients with atherosclerotic backgrounds, whose limb shaking usually vanishes after treatment [ 7 ], patients with Moyamoya disease experience more controversial outcomes after treatment.…”

Section: Discussionmentioning

confidence: 96%

A case of limb shaking transient ischaemic attack due to internal carotid artery dissection: an unusual presentation of fibromuscular dysplasia

Liu

Lei

et al. 2023

BMC Neurol

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Background Fibromuscular dysplasia (FMD) has a high prevalence of associated nontraumatic carotid artery dissection, which could further result in transient ischaemic attack (TIA) or stroke. Limb shaking TIA is an unusual form of TIA that is commonly discribed in elderly patients with atherosclerotic backgrounds, while there are limited data about it in patients with FMD. Furthermore, discussions of limb shaking TIA in nonelderly patients are scarce. Case presentation An Asian 47-year-old female presented with intermittent involuntary movement of the left upper limb accompanied by neck torsion. The episode stopped soon after changing to the supine position. On native source images of time-of-flight magnetic resonance angiography (TOF-MRA), the right internal carotid artery showed a "dual lumen sign" with an intimal flap. On contrast-enhanced magnetic resonance angiography and sagittal black-blood T1WI, an intravascular haematoma with irregular lumen stenosis was observed, which overall indicated right internal carotid artery dissection. Digital subtraction angiography showed the characteristic “string-of-beads” appearance in the left internal carotid artery, and the presence of this sign pointed to the diagnosis of FMD. The patient was finally diagnosed with limb shaking TIA due to internal carotid dissection with fibromuscular dysplasia. The patient was prescribed dual anti-platelet therapy. The limb shaking vanished soon after admission with no reoccurrence in the three-month follow-up. Conclusions This case demonstrates that limb shaking TIA can present in patients with FMD. Limb shaking TIA in nonelderly patients can be caused by multiple diseases, and more detailed patient guidance is required in clinical practice.

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Section: Discussionmentioning

confidence: 96%

A case of limb shaking transient ischaemic attack due to internal carotid artery dissection: an unusual presentation of fibromuscular dysplasia

Liu

Lei

et al. 2023

BMC Neurol

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“…A small sample study showed that patients with moyamoya angiopathy complicated by posterior cerebral artery (PCA) stenosis were more likely to develop LS-TIA due to diminished maintenance of the anterior circulation by leptomeningeal collaterals from the PCA. 11 However, the physiological mechanism of limb shaking in brainstem infarction remains unclear. It may be that spinal myoclonic jerks, which are similar to shakings, are induced by ischemia of the cervical spinal cord due to occlusion of the right vertebral artery.…”

Section: Discussionmentioning

confidence: 99%

Limb-shaking transient ischemic attack in posterior circulation ischemia: a case report

Zhao

Qin

2022

J Int Med Res

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Limb-shaking transient ischemic attack (LS-TIA) is a rare clinical manifestation of steno-occlusive carotid lesions. Reports of LS-TIA caused by posterior circulation ischemia are rare. Here, the case of a 56-year-old male patient with a history of epilepsy, who presented with dizziness, nausea and vomiting, is reported. Initial brain magnetic resonance imaging (MRI) indicated no signs of acute ischemia, and the patient’s symptoms had not relieved despite drug administration to treat dizziness. During a vestibular function test on the next day, he developed sudden left-limb shaking without disturbance of consciousness or facial twitching. Considering a seizure, an anti-epileptic drug was administered, but no improvement was observed. Eight hours later, the patient experienced left-limb paralysis, and re-examination of the MRI indicated brainstem infarction. The patient recovered well with antiplatelet and antiatherosclerotic therapy. While LS-TIA is a rare manifestation of TIA of the carotid arterial system, posterior circulation ischemia may also manifest as LS-TIA. If a patient presents with limb shaking due to postural changes despite a history of epilepsy, LS-TIA should be highly suspected.

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“…The recent epidemiological studies from around the globe have hinted toward a trend of the shift of the highest peak of incidence from children to adults, probably due to increased prevalence of comorbid stroke in adults and reclassification of previously misdiagnosed MMA for atherosclerotic disease due to improved diagnostic tools availability lately among adults (4,7,10,17). However, for reasons unknown, childhood MMA peak remains predominant in our (53)(54)(55). We observed a substantial number of patients (41.3%) with a history of an immediate precipitating factor in close temporal association to the onset of symptoms.…”

Section: Overallmentioning

confidence: 97%

Epidemiology of Moyamoya Angiopathy in Eastern India

et al. 2022

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IntroductionMoyamoya angiopathy (MMA) is a chronic, progressive intracranial vasculopathy with variation in prevalence and clinical manifestations across different populations. This study was aimed to estimate the frequency of MMA as an etiology of stroke and its epidemiological features in the largest cohort of MMA patients in India.MethodA single-centered cross-sectional observational study over a period of 5 years (2016–2021) was undertaken among consecutive stroke and transient ischemic attack (TIA) patients to look for the presence of MMA angiographically. Each patient with angiographically proven MMA was further evaluated for demographic, clinical, and radiological characteristics.ResultsAmong 10,250 consecutive stroke and TIA patients (ischemic = 78%, hemorrhagic = 22%), frequency of MMA was 1.56% (n = 160); 15.3% among children. Female preponderance (Male:Female = 1:1.4) was noted among 160 MMA patients, with bimodal age distribution, first peak at 3–8 years, and a shorter second peak at 41–47 years. Childhood-onset MMA was seen in 75 (46.9%) with commonest initial neurological symptom of fixed-motor-weakness (44.0%), followed by TIA (26.7%); while 85 (53.1%) had adult-onset MMA with fixed-motor-weakness (50.6%) followed by headache (24.7%) as the predominant initial neurological symptom; seizure significantly higher in children (p < 0.001) and headache in adults (p = 0.012). Transient and fixed neurological manifestations constituted 87.5 and 69.4% respectively, of symptoms throughout the disease course. Cerebral infarction (45.0%) and TIA (21.9%) were the commonest types of MMA. On brain imaging, infarction was noted in 80.6%, hemorrhage in 11.3%, significantly higher among adults (p < 0.001). Cortical infarct and Gyral pattern were commoner in children (p = 0.004), subcortical infarcts in adults (p = 0.018). Frequent Suzuki staging observed was stage 4 (31.3%), followed by stage 3 (30.0%). Involvement of posterior circulation was detected in 55.6%, brain atrophy at the time of diagnosis was seen in 65.0%.ConclusionMMA is an important etiological consideration in patients with stroke, especially in children. It can present with a myriad of transient neurological symptoms, frequently overlooked, leading to delayed diagnosis, and contributing to socio-economic burden. Indian MMA showed aberrations in its gender predisposition, age distribution, frequency of familial cases, disease manifestation, and type of stroke, in comparison to its Japanese and Caucasian counterparts pointing to the inter- and intra-continent differences of MMA phenotype. Future development of the Indian MMA national registry is of essence.

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Limb-shaking TIA in Moyamoya angiopathy

Cited by 18 publications

References 16 publications

A case of limb shaking transient ischaemic attack due to internal carotid artery dissection: an unusual presentation of fibromuscular dysplasia

A case of limb shaking transient ischaemic attack due to internal carotid artery dissection: an unusual presentation of fibromuscular dysplasia

Limb-shaking transient ischemic attack in posterior circulation ischemia: a case report

Epidemiology of Moyamoya Angiopathy in Eastern India

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