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首页> 外文期刊>The Internet Journal of Neurology >Limb-Shaking Transient Ischemic Attacks: Diagnosis, Prognosis, and Management
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Limb-Shaking Transient Ischemic Attacks: Diagnosis, Prognosis, and Management

机译：肢体短暂性短暂性脑缺血发作：诊断，预后和管理。

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Limb-shaking transient ischemic attacks (LSTIAs) are a rare manifestation of carotid occlusive disease. We report the case of an 81 year old woman who presented with recurrent LSTIAs and received conservative treatment with cessation of her anti-hypertensive medications. Multi-Slice Detector CT Angiography (MSCTA) demonstrated a right internal carotid artery occlusion with evidence of cerebral autoregulatory compensation via leptomeningeal vessels. This case characterizes LSTIAs and demonstrates the use of MSCTA in diagnosis, prognosis, and management. Introduction Limb-shaking transient ischemic attacks (LSTIAs) are a rare manifestation of cerebral ischemia due to severe internal carotid artery stenosis or occlusion. 1 Multi-Slice Detector CT angiography (MSCTA) is an emerging non-invasive technique that can quickly examine the neurovascular circulation from the Great Vessels to the distal leptominengeal branches of the cerebral vasculature. Its utility in the emergent evaluation of complex neurovascular disease is becoming increasingly recognized. 2 This case explores the phenomena of LSTIA and demonstrates the use of MSCTA to identify occlusive carotid vascular disease and outline downstream collateral circulation/autoregulatory compensatory responses important in carotid disease reoccurrence prediction. Case Report An 81 year old left handed woman presented with left arm “shaking.” She reported repeated rhythmic finger extension with anterior forearm protrusion in discrete 15-20 minute episodes over a 2 hour period. At onset, the patient was standing and performing lower extremity exercises. She also experienced a 30 minute episode of word finding difficulty in the emergency department (ED). Her past medical history included a permanent pacemaker, hypertension, hyperlipidemia, coronary artery disease, and atrial fibrillation without anticoagulation. Ten months prior to presentation, the patient had a TIA with word finding difficulties and left arm numbness; a 95% right internal carotid artery (ICA) stenosis was noted on MSCTA at that time.Examination in the emergency department, approximately 4 hours after symptom onset, was significant for an irregularly irregular pulse, a blood pressure of 158/72 and a mild pronator drift of the left upper extremity. Non-contrast head CT (NCHCT) was negative for acute signs of infarction. MSCTA demonstrated a right ICA occlusion at the bifurcation. The left ICA was normal with diminutive posterior communicating arteries. Insular and cortical branches were prominent throughout the right middle cerebral artery territory suggestive of autoregulatory dilation to draw collaterals from the Circle of Willis and leptomeningeal vessels. (see Figure 1) An electroencephalogram was negative for epileptiform activity. The patient had an uneventful hospital course with slow reintroduction of blood pressure medications. Anticoagulation was held for a planned surgery of an incidental mass discovered on chest x-ray. On the day following discharge, she experienced a second left arm shaking episode and transient left hemiparesis that resolved with sitting. On readmission, the patient was not orthostatic and a NCHCT was unchanged from the previous admission. She was discharged with compression stockings and instructed to stop her antihypertensives indefinitely.
机译：晃动性短暂性脑缺血发作（LSTIAs）是颈动脉闭塞性疾病的罕见表现。我们报道了一名81岁女性，该患者出现复发性LSTIAs，并因停用抗高血压药物而接受了保守治疗。多层螺旋CT血管造影（MSCTA）显示右颈内动脉闭塞，并有通过软脑膜血管进行脑自动调节补偿的证据。该案例表征了LSTIAS，并证明了MSCTA在诊断，预后和管理中的应用。简介由于严重的颈内动脉狭窄或闭塞，肢体晃动的短暂性脑缺血发作（LSTIAs）是脑缺血的一种罕见表现。 1多层​​检测器CT血管造影（MSCTA）是一种新兴的非侵入性技术，可以快速检查从大血管到大脑脉管系统的远端小脑分支的神经血管循环。它在复杂神经血管疾病的紧急评估中的效用日益受到认可。 2该案例探讨了LSTIA现象，并证明了MSCTA用于识别闭塞性颈动脉疾病并概述了下游侧支循环/自动调节代偿性反应，对颈动脉疾病复发的预测很重要。病例报告一名81岁的左撇子妇女左臂“晃动”。她报告说，在2小时内，重复的节律性手指伸展和前臂前伸在15-20分钟内不连续发作。发病时，患者站立并进行下肢运动。她还在急诊室（ED）经历了30分钟的找词困难情节。她过去的病史包括永久性起搏器，高血压，高脂血症，冠状动脉疾病和未经抗凝的房颤。出诊前10个月，患者患有TIA，出现单词发现困难和左臂麻木。当时在MSCTA上发现95％的右颈内动脉（ICA）狭窄。在症状发作后约4小时，在急诊科进行检查对于不规则的不规则脉搏，血压158/72和轻度有重要意义左上肢的前旋肌漂移。非造影性头部CT（NCHCT）对急性梗死体征阴性。 MSCTA在分叉处显示出正确的ICA闭塞。左ICA正常，后交通动脉小。岛状和皮层分支在整个右中脑动脉区域突出，提示自调节性扩张从威利斯环和软脑膜血管吸引侧支。 （参见图1）脑电图癫痫样活动为阴性。该患者住院过程平稳，血压药物重新缓慢引入。针对计划在胸部X射线上发现的意外肿块进行了计划的抗凝治疗。出院后的第二天，她经历了第二次左臂摇晃发作和短暂的左偏瘫，坐姿消退。重新入院时，患者未体位，并且NCHCT与之前的入院时间相同。她因压力袜而出院，并被指示无限期停止服用降压药。

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