Limb-shaking transient ischemic attack masquerading as lumbar radiculopathy from pericallosal artery stenosis treated successfully with intracranial angioplasty and stenting.
The pericallosal artery is rarely associated with intracranial atherosclerotic disease and, until recently, was usually not amenable to endovascular therapy with balloon angioplasty and stenting. We present an elderly patient with postural left leg-shaking episodes secondary to pericallosal artery stenosis, which was treated initially with primary intracranial balloon angioplasty, and subsequently, angioplasty and stenting as a result of recurrent stenosis. Both procedures were preformed without complications, and the patient remained free of symptoms on 6-month follow-up. This case demonstrates unique clinical and neuroendovascular aspects; the isolated postural leg-shaking transient ischemic attacks, initially mistaken for radiculopathy and local joint etiology, were found later to be cerebrovascular ischemic in origin. Moreover, the correlation between the findings of computed tomography perfusion and angiography localized the lesion into the medial frontal lobe and pericallosal artery territory. In addition, the technical aspect provides insight into the current state of neuroendovascular techniques, addressing the difficulty of access into very small and distal intracranial arteries affected by stenosis.
Kalia
Junaid
J
Department of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, WI 53226, USA.
Wolfe
Thomas
T
Zaidat
Osama O
OO
D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods*; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography; D003337:Corpus Callosum / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D020243:Infarction, Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D007866:Leg / Q000294:innervation / Q000503:physiopathology*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D009044:Motor Cortex / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D011843:Radiculopathy / Q000175:diagnosis / Q000503:physiopathology; D012008:Recurrence; D012086:Reoperation; D055009:Spondylosis / Q000175:diagnosis / Q000503:physiopathology; D015607:Stents / Q000592:standards*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014202:Tremor / Q000209:etiology / Q000503:physiopathology / Q000628:therapy