An Unusual Cause of Transient Neurologic Deficits: Compression of the Carotid Artery by a Thyroid Cystic Nodule

Braakman, Hilde M. H.; Knippenberg, Stephanie; Bondt, Bert-Jan de; Lodder, J.

doi:10.1016/j.jstrokecerebrovasdis.2009.02.007

Cited by 6 publications

(7 citation statements)

References 6 publications

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“…The hemodynamic mechanism of LSTIAs is further supported not only by the observation that in our patient all symptoms started after the attempts to manage his poorly-controlled hypertension, but also from other reports where symptoms were elicited by orthostatic hypotension, 6,7 postprandial hypotension, 8 hypertension control in association with complete carotid occlusion successfully managed with antihypertensive dose reduction, 9 external compression, 10 or balloon occlusion, 11 of the carotid artery. During evolvement of symptoms in a patient in one study, a dramatic decrease of flow velocities in the left middle cerebral artery was observed on transcranial Doppler, a finding that further support the hemodynamic theory.…”

Section: Discussionsupporting

confidence: 80%

A Rare Presentation of a Patient with Limb-Shaking TIA due to Severe Carotid Artery Stenosis

Sk¹,

Lampropoulos²,

Zampakis³

et al. 2015

Surg Res Open J

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Citation Case ReportABSTRACT Background: A limb-shaking Transient Ischemic Attack (TIA) is a rare neurological symptom of hemodynamic origin caused by severe carotid artery disease. Physicians should be aware of its presence because it has a non-typical presentation and is cured by endarterectomy or stenting of the stenosed carotid artery. The aim of the present study was to describe a rare case of limb-shaking TIA. Description of case: A 76 year-old man with a 80% right internal carotid artery stenosis presented with numerous episodes of involuntary jerky movements of his left arm and leg, associated with episodes of brief weakness of the left leg, caused by preoperative optimization of his hypertension. No stroke ensued despite the daily appearance of symptoms for several months. Limb-shaking TIA was diagnosed and all symptoms disappeared immediately after an uncomplicated carotid endarterectomy was performed. Conclusion: The clinical presentation of this limb-shaking TIA case, the first to our knowledge to appear during treatment of hypertension, supports further the hemodynamic theory of limbshaking TIAs.

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Section: Discussionsupporting

confidence: 80%

A Rare Presentation of a Patient with Limb-Shaking TIA due to Severe Carotid Artery Stenosis

Sk¹,

Lampropoulos²,

Zampakis³

et al. 2015

Surg Res Open J

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“…Some authors reported hot-spicy food, 79 hyperventilation, 25 post-prandial, 18 and specific head position changes as provoking factors. 42 At least 1 episode of monocular transient vision loss was observed in 9 individuals. The most common vessel involved in the development of limb-shaking was the internal carotid artery in 74 cases, especially the extracranial segment.…”

Section: Resultsmentioning

confidence: 98%

“…In 49 cases, the trigger was changing body position, such as standing. Some authors reported hot-spicy food, 79 hyperventilation, 25 post-prandial, 18 and specific head position changes as provoking factors 42 …”

Section: Resultsmentioning

confidence: 99%

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Limb-Shaking And Transient Ischemic Attack

Pitton Rissardo,

Fornari Caprara

2023

The Neurologist

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Background: Limb-shaking is one of the transient ischemic attacks (TIA) ‘chameleons.’ This literature review aims to evaluate the clinical, epidemiological profile, pathologic mechanisms, and management of limb-shaking TIA. Review Summary: Relevant reports in Medline’s (PubMed) database were identified and assessed by 2 reviewers without language restriction from 1985 to 2022. A total of 82 reports containing 161 cases that developed limb-shaking TIA were reported. The mean and median age were 61.36 (SD: 15.29) and 62 years (range: 4–93 y). Most of the individuals affected were males (64.34%). Limb-shaking was reported as unilateral in 83.33% of the patients. Limb-shaking presented with other neurological deficits in 44.33% of the individuals, in which the most common concurrent neurological deficit was the weakness of at least 1 limb. A recurrence of the “shaking” phenomenon was observed in 83 individuals. A trigger of limb-shaking was reported in 69 cases, and the most common was changing body position. The internal carotid artery was the most frequent vessel involved in limb-shaking. A chronically occluded internal carotid artery was observed in 42 individuals. Hypertension was the most common comorbidity. The management was conservative in 42.30% of the cases. The most frequent misdiagnoses were seizures. A full recovery was achieved in 56.60% of the individuals. Conclusions: Limb-shaking TIA could be defined as involuntary, rhythmic, brief (<5 min), recurrent, jerky movement usually precipitated by activities that may reduce cerebral blood flow. The “shaking” phenomenon was primarily described as a manifestation of symptomatic complete internal carotid artery obstruction.

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“…www.tmg.org.rs neoplasms of neck or head can also cause symptoms of the TIA, by mechanism of compression, infiltration, or vascular steal phenomenon [7]. Although it could just be a coincidence, hypervascularized metastasis of PTC neck tumour in this case could cause TIA symptoms by mechanism of carotid compression or steal phenomenon in physical activity.…”

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confidence: 76%

Transient ischaemic attack at the admission unit: Expect the unexpected

Lucic-Prokin¹,

Živanović²,

Lukić³

et al. 2015

Tim Med Glas

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Sažetak:51-godišnji muškarac je pregledan u prijemnoj ambulantni Urgentnog Centra, zbog ponavljanih ataka desnostranog piramidnog deficita i sumnjom na tranzitorni ishemijski atak. Neurološki i fizikalni nalaz je bio uredan, osim registrovane ovalne, bezbolne, nepokretne tumorske mase, lokalizovane pored sternokleidomastoidnog mišića, na levoj strani vrata. CT mozga i neuroultrazvučne dijagnostičke metode su bile uredne. CT vrata sa kontrastom i CT angiografija su prikazale bogato-vaskularizovanu tumorsku masu, bez kompresije na okolne vaskularne strukture. Isključena je stenoza karotidne arterije i dijagnostikovana patološka vaskularizacija tumora iz spoljašnje karotidne arterije. Nakon hirurške resekcije tumora, patohistološki nalaz je potvrdio metastazu papilarnog karcinoma tiroidne žlezde. Ključne reči: tranzitorni ishemijski atak, karotidna arterija, papilarni karcinom tiroidne žlezde Summary:We report a 51-year-old Caucasian male admitted at the Admission Unit of the Emergency Centre with recurrent right-sided hemiparesis suggesting transient ischemic attack. Neurological and physical examination was normal, save for the oval, painless, immobile tumour mass at the left side of the neck, near the sternocleidomastoid muscle. Imaging of brain parenchyma and vascular structures were normal. A contrast neck CT scan and neck CT angiography verified well-vascularised cervical tumour mass of the left side, without compression on the surrounding blood vessels. CT angiography excluded carotid artery stenosis, but revealed pathological vascularisation of cervical tumour mass from external carotid artery. Surgical resection of the cervical mass was done and histopathological analysis revealed metastasis of papillary thyroid carcinoma.

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An Unusual Cause of Transient Neurologic Deficits: Compression of the Carotid Artery by a Thyroid Cystic Nodule

Cited by 6 publications

References 6 publications

A Rare Presentation of a Patient with Limb-Shaking TIA due to Severe Carotid Artery Stenosis

A Rare Presentation of a Patient with Limb-Shaking TIA due to Severe Carotid Artery Stenosis

Limb-Shaking And Transient Ischemic Attack

Transient ischaemic attack at the admission unit: Expect the unexpected

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