Limb-Shaking TIA Presenting as Hemichorea-Hemiballismus: TIA Chameleons Diagnostic Challenge in the Emergency Department.
BACKGROUND
demonstrate the importance of considering limb-shaking syndrome in the differential diagnosis of patients who present to the emergency department (ED) with hyperkinetic movements.


METHODS
In this article, we describe a diagnostic challenge in the ED in which a patient presents with hyperkinetic movements that are initially diagnosed as hemichorea-hemiballismus (HCHB) but are subsequently found to be limb-shaking syndrome with important therapeutic opportunities.


RESULTS
Following a diagnosis of left carotid obstruction, the patient underwent left carotid endarterectomy 5 days after admission. Six months after surgery, the patient had no further symptoms, and an ultrasound scan and magnetic resonance angiography have confirmed no restenosis.


CONCLUSIONS
Limb shaking is an uncommon form of transient ischemic attack that should be recognized and differentiated from conditions such as focal motor seizures. Recognition will almost invariably indicate carotid artery occlusion, and timely treatment may not only abolish the attacks in patients but also reduce their risk of stroke. HCHB represents a spectrum of hyperkinetic movement disorders varying in the severity of choreic and/or ballistic movements. The presented case includes limb-shaking syndrome in the differential diagnosis and prompts for further investigations to complete the assessment.
Department of Accident and Emergency Medicine, Southport and Ormskirk, NHS Trust, Southport, UK. Electronic address: joa51274@hotmail.com.
Joaquin Valle
JV
Alonso
Department of Critical Care and Emergency Medicine, Ambulance service, Montoro, Córdoba, Spain.
Francisco Javier Fonseca
FJ
del Pozo
Department of Primary Care, Primary Care Health Center, Montoro, Córdoba, Spain.
Jesús Carmona
JC
Simón
Department of Neurology, Hospital Reina Sofia, Córdoba, Spain.
Saray
S
Valenzuela
Department of Primary Care, Primary Care Health Center, Montoro, Córdoba, Spain.
Francisca
F
Perez Gomez
Department of Critical and Emergency Medicine, Hospital Valle de los Pedroches, Pozoblanco, Spain.
Elisa
E
Lopera
D020820:Dyskinesias / Q000209:etiology*; D004636:Emergency Service, Hospital; D005121:Extremities / Q000503:physiopathology*; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014202:Tremor / Q000150:complications*
TIA; carotid stenosis; hemichorea–hemiballismus; hyperkinetic movements; limb shaking; stroke