title: Bilateral asymmetrical asterixis as limb-shaking transient ischemic attack in bilateral carotid stenosis.
abstract: Asterixis as limb-shaking transient ischemic attack (TIA) is rare and poorly understood. Bilateral asymmetrical asterixis as limb-shaking TIA has not been reported in carotid stenosis. A 69-year-old gentleman presented with a TIA episode (dysarthria, right-arm weakness, and numbness). Bilateral asterixis was observed and was more severe on the right side. No prior infarcts were noted in the thalamus. Liver function was normal. A computerized tomography angiogram revealed 85%stenosis of the right internal carotid artery (ICA) and 65% stenosis of the left ICA. Three days after left ICA endarterectomy, the patient had complete disappearance of bilateral asterixis, with the right side showing initial improvement. The bilateral asterixis observed is proposed to be secondary to hemodynamic impairment and hypoperfusion of certain brain territory with resolution on revascularization.
authors.affiliation: Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Shaida
authors.initials: S
authors.lastname: Khan
authors.affiliation: School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Eric
authors.initials: E
authors.lastname: Chang
authors.affiliation: School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Georgia
authors.initials: G
authors.lastname: Saniuk
authors.affiliation: Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: ty.shang@utsouthwestern.edu.
authors.forename: Ty
authors.initials: T
authors.lastname: Shang
mesh_terms: D000368:Aged; D000792:Angiography; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D020820:Dyskinesias / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D016894:Endarterectomy, Carotid; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D016896:Treatment Outcome
keywords: Carotid stenosis; asterixis; carotid endarterectomy; limb shaking TIA