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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] [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.
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Okune S, Hayakawa M, Hino T, Hiramine T, Akimoto T, Sato M, Ito Y, Marushima A, Takada T, Ishikawa E, Tamaoka A, Matsumaru Y. Transient Hemichorea-hemiballism Induced by a Combination of Postprandial Hypotension and Severe Stenosis of the Innominate Artery Concomitant with Left Carotid Occlusion. Intern Med 2024; 63:577-582. [PMID: 37407451 PMCID: PMC10937142 DOI: 10.2169/internalmedicine.0633-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 05/28/2023] [Indexed: 07/07/2023] Open
Abstract
Hemichorea-hemiballism (HCHB) due to transient ischemic attacks (TIAs) is rare. An 83-year-old woman had repeated episodes of right-sided HCHB for 3 months. Magnetic resonance (MR) angiography demonstrated occlusion of the left carotid and middle cerebral arteries and severe stenosis of the innominate artery, and 24-hour ambulatory blood pressure monitoring showed a blood pressure decrease of >20 mmHg after each meal. We speculated that HCHB developed as TIAs due to hemodynamic failure in the left cerebral hemisphere, caused by a combination of severe stenosis of the innominate artery concomitant with occlusion of the left carotid and middle cerebral arteries as well as postprandial hypotension.
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Affiliation(s)
- Sho Okune
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurology, Faculty of Medicine, University of Tsukuba, Japan
| | - Mikito Hayakawa
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Japan
| | - Tenyu Hino
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
| | - Takato Hiramine
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
| | - Taisuke Akimoto
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Masayuki Sato
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Yoshiro Ito
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Aiki Marushima
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | | | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Akira Tamaoka
- Department of Neurology, Faculty of Medicine, University of Tsukuba, Japan
| | - Yuji Matsumaru
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
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Ikenouchi H, Yoshimoto T, Ihara M. Postprandial cerebral infarction. J Clin Neurosci 2021; 94:38-40. [PMID: 34863460 DOI: 10.1016/j.jocn.2021.09.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/13/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
Some neurological diseases are accompanied by autonomic dysfunction. Postprandial hypotension (PPH) is one disorder accompanied by autonomic dysfunction. Although the major symptoms of PPH are fall and syncope, PPH is sometimes overlooked because of its non-specific symptoms, such as dizziness, nausea, and light-headedness. Because PPH could result in decreased cerebral perfusion pressure accompanied by a decrease in blood pressure, PPH may be linked to the risk of hemodynamic stroke or transient ischemic events, especially in patients with chronic cerebral large vessel occlusion/stenosis. Whether chronic cerebral large vessel occlusion or stenosis causes symptomatic ischemic events depends on the patient's compensatory collateral circulation and cerebral vasoreactivity. Therefore, we hypothesized that cerebral blood flow assessment could be essential for stratifying patients at high risk of postprandial cerebral infarction. However, there have been few reports on the association between cerebral blood flow and the occurrence of postprandial cerebral infarction. In a literature review, we identified seven cases of postprandial cerebral infarction. Postprandial cerebral infarction occurs in patients with chronic cerebral large vessel occlusion/stenosis accompanied by cerebral blood flow reduction. Non-pharmacotherapeutic and pharmacotherapeutic approaches could improve postprandial cerebral infarction; however, one patient with poor compensatory collateral circulation and reduced cerebral vasoreactivity experienced recurrent symptomatic episodes even with sufficient medical treatment and needed extracranial-intracranial bypass surgery. Physicians should be aware of PPH as it can complicate neurological disorders. Long-term blood pressure monitoring for the detection of PPH and cerebral blood flow assessment is needed in patients with cerebral large vessel occlusion/stenosis to prevent postprandial cerebral infarction.
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Affiliation(s)
- Hajime Ikenouchi
- Department of Neurology, National Cerebral and Cardiovascular Center, Japan
| | - Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Japan.
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Postprandial Hypotension and Coma Following Subarachnoid Hemorrhage in a Patient with Parkinson's Disease. J Stroke Cerebrovasc Dis 2016; 25:e58-61. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/05/2016] [Accepted: 01/11/2016] [Indexed: 11/23/2022] Open
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Noda K, Nakajima S, Sasaki F, Ito Y, Kawajiri S, Tomizawa Y, Hattori N, Yamamoto T, Okuma Y. Middle Cerebral Artery Occlusion Presenting as Upper Limb Monochorea. J Stroke Cerebrovasc Dis 2015; 24:e291-3. [PMID: 26294216 DOI: 10.1016/j.jstrokecerebrovasdis.2015.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/30/2015] [Accepted: 06/10/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hemichorea is usually caused by a structural lesion in the contralateral basal ganglia or subthalamic nuclei or it develops as a form of a neurologic complication including hyperglycemia. We report a rare case of a patient who developed choreic movement in the right upper extremity associated with a contralateral middle cerebral artery (MCA) occlusion. METHODS A 76-year-old man presented with chorea in the right upper limb, known as monochorea, which occurred after recovery from losing consciousness while standing. He was found to have idiopathic orthostatic hypotension. His diffusion-weighted magnetic resonance imaging did not show signal changes indicative of acute ischemic lesions. A left carotid artery angiogram showed occlusion of the left MCA. (123)I-N-isopropyl-4-iodoamphetamine single-photon emission computed tomography of the brain showed marked hypoperfusion in the left MCA territory. His cerebrovascular reserve capacity determined using acetazolamide was relatively decreased in this territory. This decrease in cerebrovascular reserve capacity, however, did not require surgical treatment, such as extracranial-intracranial bypass surgery. RESULTS The recurrence of chorea was not observed after antiplatelet therapy and instruction on how to cope with orthostatic hypotension. CONCLUSIONS It is considered that transient hemodynamic ischemia in the right basal ganglia-thalamocortical circuits because of the combination of MCA occlusion and hypotension was the underlying cause of the monochorea in this patient.Vascular imaging studies for early identification of occlusion or severe stenosis of cerebral major arteries should be carried out in patients acutely presenting with chorea, even in the absence of other clinical signs.
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Affiliation(s)
- Kazuyuki Noda
- Department of Neurology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
| | - Sho Nakajima
- Department of Neurology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan; Department of Neurology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Fuyuko Sasaki
- Department of Neurology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan; Department of Neurology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Yoshitaka Ito
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Sumihiro Kawajiri
- Department of Neurology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Yuji Tomizawa
- Department of Neurology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Takuji Yamamoto
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Yasuyuki Okuma
- Department of Neurology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
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Son JT, Lee E. Postprandial hypotension among older residents of a nursing home in Korea. J Clin Nurs 2012; 21:3565-73. [DOI: 10.1111/j.1365-2702.2011.04033.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Haemodynamic stroke is a type of ischaemic stroke that is caused by hypoperfusion rather than by embolism or local vasculopathy. It can be caused by systemic diseases such as heart failure or hypotension, but also by severe obstruction of the carotid or vertebral arteries. Patients with haemodynamic stroke or transient ischaemic attack might show specific clinical features that distinguish them from patients with embolism or local small-vessel disease. Ancillary investigations of cerebral perfusion can show whether blood flow to the brain is compromised and provide important prognostic information. Management of patients who have hypoperfusion as the major cause of ischaemic stroke or as a contributing factor is hampered by the lack of clinical trials. Treatment aimed at increasing cerebral blood flow might be considered in selected patients on the basis of information from case series. Further research is needed to define criteria for the diagnosis of haemodynamic stroke and to investigate treatment options in controlled studies.
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Affiliation(s)
- Catharina J M Klijn
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, Netherlands.
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Luciano GL, Brennan MJ, Rothberg MB. Postprandial hypotension. Am J Med 2010; 123:281.e1-6. [PMID: 20193838 DOI: 10.1016/j.amjmed.2009.06.026] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 06/21/2009] [Accepted: 06/24/2009] [Indexed: 12/01/2022]
Abstract
Postprandial hypotension is both common in geriatric patients and an important but under-recognized cause of syncope. Other populations at risk include those with Parkinson disease and autonomic failure. The mechanism is not clearly understood, but appears to be secondary to a blunted sympathetic response to a meal. This review discusses the epidemiology, risk factors, and pathophysiology of postprandial hypotension in the elderly, as well as diagnosis and treatment strategies. Diagnosis can be made based on ambulatory blood pressure monitoring and patient symptoms. Lifestyle modifications such as increased water intake before eating or substituting 6 smaller meals daily for 3 larger meals may be effective treatment options. However, data from randomized, controlled trials are limited. Increased awareness of this disease may lead to improved quality of life, decreased falls and injuries, and the avoidance of unnecessary testing.
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Persoon S, Kappelle LJ, Klijn CJM. Limb-shaking transient ischaemic attacks in patients with internal carotid artery occlusion: a case-control study. Brain 2010; 133:915-22. [PMID: 20157011 DOI: 10.1093/brain/awq009] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Suzanne Persoon
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands.
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