Clinical Analysis On 6 Cases Of Limb-shaking Transient Ischemic Attack

BACKGROUNDTransient ischemic attack (TIA) is a kind of transient neurological impairment caused by focal cerebral or retina ischemia, which covers two types:internal carotid artery (ICA) system of TIA and vertebrobasilar system of TIA. Clinical manifestation generally lasts less than one hour, not exceeds 24 hours. The pathological mechanism of TIA include changes of hemodynamic as well as microembolus. Limb-shaking transient ischemic attack (LS-TIA) characterized by brief (lasting from a few seconds to minutes), stereotyped, and arrhythmic involuntary hyperkinesias affecting unilateral limb or bilateral limbs has been regarded as a relatively-rare form of internal carotid artery system TIA. In general, severe stenosis or occlusion of the contralateral cerebrovascular is presented in LS-TIA patients, and the most common artery is extracranial internal carotid artery. Lesion occurring in other intracranial arteries, such as middle cerebral artery (MCA), anterior cerebral artery (ACA), the siphonic part of ICA, terminal ICA and pericallosal artery, also are the main causes of LS-TIA. High-grade stenosis or occlusion in extracranial and intracranial arteries can result in some degree damage of cerebral autoregulation. An almost invariable phenomenon clinically is that symptoms appear after certain inducement which theoretically leads to cerebral blood hypoperfusion, such as walking for a long time, standing up from a bed or a chair, hyperextending the neck, hyperventilation, as well as excessive hypotension. Although more deeply study on pathogenesis, clinical features, offending artery, imaging changes and therapies have been reported, LS-TIA patients are still probably misdiagnosed for focal seizures or extrapyramidal diseases as a result of the particular hyperkinetic movements. The risk, of ischemic stroke will increase by reason of cerebrovascular assessment and timely treatment deficiency.OBJECTIVETo probe the pathogenesis, clinical manifestations, imaging changes and treatment of LS-TIA in order to improve the accuracy as well as promptness of diagnosis and treatment.METHODSA retrospective analysis was performed on clinical manifestation, auxiliarty examination, treatment and prognosis of 6 cases who were diagnosed as LS-TIA between October 2014 and January 2016 in the Second Hospital of Shandong University.RESULTSThere are six patients in Our study,3 males and 3 female, male to female ratio was 1:1. The onset age from 52-84y, an average is 64.67y. Among them,5 cases made limb shaking as initial symptom, and 1 case were found to have limb shaking on the basis of paresis. The clinical attacks, which were induced by predisposing factors, usually exhibited in unilateral or bilateral limbs. The patients suffered 1-6 attacks and usually lasting 0.5-10 minutes each time. The attacks did not involve disturbance of consciousness as well as no shaking in the face and trunk. All the patients had vascular assessment, characterized by intracranial or/and extracranial artery stenosis or occlusion in the contralateral side. After given anti-platelet and statin therapy were given, the clinical symptoms of all patients were controlled. During the whole follow-up time, with the exception of lease, other 5 cases had no cerebrovascular events.CONCLUSIONSLimb-shaking transient ischemic attack is a special and uncommon form of TIA, generally indicating severe stenosis or occlusion in the contralateral extracranial or intracranial artery. Standard drug-based therapy and revascularization might be valid in terminating attack and reducing risk of stroke.