{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T14:29:09Z","timestamp":1794061749227,"version":"4.8.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,7,3]],"date-time":"2021-07-03T00:00:00Z","timestamp":1625270400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,3]],"date-time":"2021-07-03T00:00:00Z","timestamp":1625270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Limb-shaking transient ischaemic attacks (TIAs) are an under recognised presentation of severe cerebrovascular disease resulting from cerebral hypoperfusion. Patients present with jerking, transitory limb movements precipitated by change in position or exercise that are often confused with seizure. Cerebral perfusion imaging studies are an important tool available to aid diagnosis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>We present the case of a young female who developed limb-shaking TIA in the context of progressive severe intracranial atherosclerotic disease (ICAD). Previous cortical infarction raised suspicion for seizure as a cause of her symptoms. However, single photon emission CT (SPECT) with CT acetazolamide challenge identified severe left hemisphere cerebral hypoperfusion and a diagnosis of limb-shaking TIA was made. Symptoms improved with maximal medical management.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This case highlights the importance of cerebral perfusion imaging for diagnostic confirmation as well as therapeutic options available to alleviate symptoms and reduce stroke risk in patients with limb-shaking TIA.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12883-021-02296-4","type":"journal-article","created":{"date-parts":[[2021,7,3]],"date-time":"2021-07-03T11:02:27Z","timestamp":1625310147000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Limb-shaking TIA: a case of cerebral hypoperfusion in severe cerebrovascular disease in a young adult"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4913-2739","authenticated-orcid":false,"given":"Tom E.","family":"Richardson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Beech","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8365-6907","authenticated-orcid":false,"given":"Geoffrey C.","family":"Cloud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,3]]},"reference":[{"key":"2296_CR1","doi-asserted-by":"publisher","unstructured":"Knoflach M, Matosevic B, Meinhart M, et al. Prognostic relevance of limb shaking in symptomatic carotid artery occlusion. Cerebrovasc Dis. 2011;32(1):35\u201340. https:\/\/doi.org\/10.1159\/000326076.","DOI":"10.1159\/000326076"},{"issue":"8","key":"2296_CR2","doi-asserted-by":"publisher","first-page":"e349","DOI":"10.1161\/01.STR.0000135024.54608.3f","volume":"35","author":"ML Flaherty","year":"2004","unstructured":"Flaherty ML, Flemming KD, McClelland R, et al. Population-based study of symptomatic internal carotid artery occlusion. Stroke. 2004;35(8):e349\u201352. https:\/\/doi.org\/10.1161\/01.STR.0000135024.54608.3f.","journal-title":"Stroke"},{"issue":"3","key":"2296_CR3","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1016\/j.jvs.2010.07.039","volume":"52","author":"S Persoon","year":"2010","unstructured":"Persoon S, Kappelle LJ, Klijn CJM. Limb-shaking transient ischaemic attacks in patients with internal carotid artery occlusion: a case-control study. J Vasc Surg. 2010;52(3):798. https:\/\/doi.org\/10.1016\/j.jvs.2010.07.039.","journal-title":"J Vasc Surg"},{"issue":"4","key":"2296_CR4","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1136\/jnnp.65.4.561","volume":"65","author":"RW Baumgartner","year":"1998","unstructured":"Baumgartner RW, Baumgartner I. Vasomotor reactivity is exhausted in transient ischaemic attacks with limb shaking. J Neurol Neurosurg Psychiatry. 1998;65(4):561. https:\/\/doi.org\/10.1136\/jnnp.65.4.561.","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"1","key":"2296_CR5","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/1471-2377-6-5","volume":"6","author":"S Ali","year":"2006","unstructured":"Ali S, Khan MA, Khealani B. Limb-shaking transient ischemic attacks: case report and review of literature. BMC Neurol. 2006;6(1):5. https:\/\/doi.org\/10.1186\/1471-2377-6-5.","journal-title":"BMC Neurol"},{"issue":"1","key":"2296_CR6","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1136\/svn-2018-000175","volume":"4","author":"MY Xu","year":"2019","unstructured":"Xu MY. Poststroke seizure: optimising its management. Stroke Vasc Neurol. 2019;4(1):48\u201356. https:\/\/doi.org\/10.1136\/svn-2018-000175.","journal-title":"Stroke Vasc Neurol"},{"key":"2296_CR7","first-page":"42","volume":"1","author":"S Prabhakaran","year":"2019","unstructured":"Prabhakaran S, Srivastava AK. Intracranial atherosclerotic disease. Pract Neurol. 2019;1:42\u20139.","journal-title":"Pract Neurol"},{"issue":"3","key":"2296_CR8","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1212\/wnl.36.3.373","volume":"36","author":"J Bogousslavsky","year":"1986","unstructured":"Bogousslavsky J, Regli F. Unilateral watershed cerebral infarcts. Neurology. 1986;36(3):373\u2013473. https:\/\/doi.org\/10.1212\/wnl.36.3.373.","journal-title":"Neurology"},{"issue":"1","key":"2296_CR9","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1097\/nrl.0000000000000208","volume":"24","author":"T Ranasinghe","year":"2019","unstructured":"Ranasinghe T, Boo S, Adcock A. Rare phenomenon of limb-shaking TIA, resolved with intracranial wingspan stenting. Neurologist. 2019;24(1):37\u20139. https:\/\/doi.org\/10.1097\/nrl.0000000000000208 [published Online First: 27 Dec 2018].","journal-title":"Neurologist"},{"issue":"5","key":"2296_CR10","doi-asserted-by":"publisher","first-page":"1420","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.10.042","volume":"27","author":"C Bund","year":"2018","unstructured":"Bund C, Heimburger C, Wolff V, et al. Positional brain single-photon emission computed tomography findings in a case of limb-shaking syndrome. J Stroke Cerebrovasc Dis. 2018;27(5):1420\u20132. https:\/\/doi.org\/10.1016\/j.jstrokecerebrovasdis.2017.10.042.","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"5","key":"2296_CR11","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1136\/practneurol-2018-002180","volume":"19","author":"JS Duncan","year":"2019","unstructured":"Duncan JS. Brain imaging in epilepsy. Pract Neurol. 2019;19(5):438. https:\/\/doi.org\/10.1136\/practneurol-2018-002180.","journal-title":"Pract Neurol"},{"issue":"3","key":"2296_CR12","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1093\/rpd\/nct280","volume":"162","author":"A Sabarudin","year":"2013","unstructured":"Sabarudin A, Yusof MZ, Mohamad M, et al. Radiation dose associated with cerebral CT angiography and CT perfusion: an experimental phantom study. Radiat Prot Dosimetry. 2013;162(3):316\u201321. https:\/\/doi.org\/10.1093\/rpd\/nct280.","journal-title":"Radiat Prot Dosimetry"},{"issue":"6","key":"2296_CR13","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1007\/s40336-014-0093-8","volume":"2","author":"M Ferrari","year":"2014","unstructured":"Ferrari M, De Marco P, Origgi D, et al. SPECT\/CT radiation dosimetry. Clin Transl Imaging. 2014;2(6):557\u201369. https:\/\/doi.org\/10.1007\/s40336-014-0093-8.","journal-title":"Clin Transl Imaging"},{"issue":"12","key":"2296_CR14","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1007\/s00234-015-1571-z","volume":"57","author":"M Grade","year":"2015","unstructured":"Grade M, Hernandez Tamames JA, Pizzini FB, et al. A neuroradiologist\u2019s guide to arterial spin labeling MRI in clinical practice. Neuroradiology. 2015;57(12):1181\u2013202. https:\/\/doi.org\/10.1007\/s00234-015-1571-z.","journal-title":"Neuroradiology"},{"issue":"3","key":"2296_CR15","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1136\/practneurol-2014-000961","volume":"15","author":"ET Littleton","year":"2015","unstructured":"Littleton ET, Glover N, Tiwari A. Recurrent amaurosis fugax and hemichorea: limb-shaking TIA. Pract Neurol. 2015;15(3):218. https:\/\/doi.org\/10.1136\/practneurol-2014-000961.","journal-title":"Pract Neurol"},{"issue":"2","key":"2296_CR16","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1097\/00006123-200208000-00033","volume":"51","author":"NL Klempen","year":"2002","unstructured":"Klempen NL, Janardhan V, Schwartz RB, et al. Shaking limb transient ischemic attacks: unusual presentation of carotid artery occlusive disease: report of two cases. Neurosurgery. 2002;51(2):483\u20137 discussion 87. [published Online First: 17 Aug 2002].","journal-title":"Neurosurgery"},{"key":"2296_CR17","doi-asserted-by":"publisher","unstructured":"Bonati LH, Kakkos S, Berkefeld J, et al. European Stroke Organisation guideline on endarterectomy and stenting for carotid artery stenosis. Eur Stroke J. 2021;6(2):1\u201347. https:\/\/doi.org\/10.1177\/23969873211012121.","DOI":"10.1177\/23969873211012121"},{"key":"2296_CR18","unstructured":"Stroke Foundation. Clinical guidelines for stroke management. Melbourne. 2021. https:\/\/informme.org.au\/Guidelines\/Clinical-Guidelines-for-Stroke-Management. Accessed 11 Jun 2021."},{"issue":"10","key":"2296_CR19","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1016\/S1474-4422(10)70185-X","volume":"9","author":"CJM Klijn","year":"2010","unstructured":"Klijn CJM, Kappelle LJ. Haemodynamic stroke: clinical features, prognosis, and management. Lancet Neurol. 2010;9(10):1008\u201317. https:\/\/doi.org\/10.1016\/S1474-4422(10)70185-X.","journal-title":"Lancet Neurol"},{"issue":"7","key":"2296_CR20","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1001\/archneur.1997.00550190090019","volume":"54","author":"EC Leira","year":"1997","unstructured":"Leira EC, Ajax T, Adams HP Jr. Limb-shaking carotid transient ischemic attacks successfully treated with modification of the antihypertensive regimen. Arch Neurol. 1997;54(7):904\u20135. https:\/\/doi.org\/10.1001\/archneur.1997.00550190090019.","journal-title":"Arch Neurol"},{"key":"2296_CR21","doi-asserted-by":"publisher","unstructured":"Orrapin S, Rerkasem K. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev. 2017;6:1\u201342. https:\/\/doi.org\/10.1002\/14651858.CD001081.pub3.","DOI":"10.1002\/14651858.CD001081.pub3"},{"issue":"1","key":"2296_CR22","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1161\/STROKEAHA.115.008220","volume":"47","author":"G Esposito","year":"2016","unstructured":"Esposito G, Amin-Hanjani S, Regli L. Role of and indications for bypass surgery after carotid occlusion surgery study (COSS)? Stroke. 2016;47(1):282\u201390. https:\/\/doi.org\/10.1161\/STROKEAHA.115.008220.","journal-title":"Stroke"},{"key":"2296_CR23","first-page":"457","volume":"41","author":"B Schaller","year":"2007","unstructured":"Schaller B. Extracranial-intracranial bypass surgery to reduce the risk of haemodynamic stroke in cerebroocclusive atherosclerotic disease of the anterior cerebral circulation - a systematic review. Neurol Neurochir Pol. 2007;41:457\u201371.","journal-title":"Neurol Neurochir Pol"},{"issue":"9914","key":"2296_CR24","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/S0140-6736(13)62038-3","volume":"383","author":"CP Derdeyn","year":"2014","unstructured":"Derdeyn CP, Chimowitz MI, Lynn MJ, et al. Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. The Lancet. 2014;383(9914):333\u201341. https:\/\/doi.org\/10.1016\/S0140-6736(13)62038-3.","journal-title":"The Lancet"},{"issue":"1","key":"2296_CR25","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1097\/NRL.0000000000000211","volume":"24","author":"TN Turan","year":"2019","unstructured":"Turan TN, Kasab SA, Nizam A, et al. Type and duration of exercise in the SAMMPRIS trial. Neurologist. 2019;24(1):10\u20132. https:\/\/doi.org\/10.1097\/NRL.0000000000000211.","journal-title":"Neurologist"},{"issue":"3","key":"2296_CR26","doi-asserted-by":"publisher","first-page":"662","DOI":"10.3171\/2014.11.Jns141553","volume":"123","author":"SW Low","year":"2015","unstructured":"Low SW, Teo K, Lwin S, et al. Improvement in cerebral hemodynamic parameters and outcomes after superficial temporal artery-middle cerebral artery bypass in patients with severe stenoocclusive disease of the intracranial internal carotid or middle cerebral arteries. J Neurosurg. 2015;123(3):662. https:\/\/doi.org\/10.3171\/2014.11.Jns141553.","journal-title":"J Neurosurg"}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-021-02296-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12883-021-02296-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-021-02296-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,3]],"date-time":"2021-07-03T11:04:04Z","timestamp":1625310244000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcneurol.biomedcentral.com\/articles\/10.1186\/s12883-021-02296-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,3]]},"references-count":26,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2296"],"URL":"https:\/\/doi.org\/10.1186\/s12883-021-02296-4","relation":{},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,3]]},"assertion":[{"value":"17 March 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 June 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 July 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable for deidentified case reports where patient consent has been provided, as per the Alfred Hospital Ethics Committee Case Report Guideline.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written consent was provided by the patient for publication of clinical details and associated imaging and is available for review by the Editor of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors report no conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"260"}}