Bilateral Limb-Shaking Transient Ischemic Attacks

Limb shaking is a rare manifestation of transient ischemic attacks (TIA) associated with carotid occlusion, mostly unilateral events. We describe the case of a 69 year-old man who presented with repeated episodes of irregular jerking movements in the bilateral upper and lower extremities, precipitated by standing up. Cerebral angiograms revealed occlusion of both internal carotid arteries, and the patient's symptoms responded to targeted blood pressure management. Physicians should be mindful of bilateral limb-shaking TIA when presented with bilateral paroxysmal events that can mimic seizures or orthostatic hyperkinesia.