Limb-shaking movement disorder – an unusual presentation during transient ischemic attack

Involuntary movements are an uncommon manifestation of transient ischemic attacks (TIAs) and are often associated with carotid occlusion or stenosis. These symptoms are frequently position-dependent, typically occurring when the patient stands or becomes hypotensive, and can be misdiagnosed as focal motor seizures. Patients presenting with this phenomenon may be at a high risk of recurrent stroke due to underlying carotid disease. We present the case of a 79-year-old woman who exhibited hyperkinetic movements on her left side. Her symptoms appeared upon transitioning from sitting to standing and were exacerbated following more aggressive antihypertensive treatment. Diagnostic imaging revealed a near-occlusion of her right carotid artery and multiple ischemic lesions in the right cerebral hemisphere. She was admitted for carotid endarterectomy, after which she became symptom-free.