Limb shaking TIA: an unusual presentation of a common condition

First described by Fischer in 1962, the limb shaking syndrome is a haemodynamic transient ischaemic attack (TIA) clinically characterised by brief, dysrhythmic, flailing or jerking movements, involving limbs contralateral to an occlusion of the internal carotid artery (ICA), which occur with a change in posture such as standing from sitting. We present the case of a woman in her 60s who presented with left-sided weakness suggestive of right hemispheric stroke, with previous episodes of limb shaking TIAs, which were caused by significant cerebral hypo-perfusion due to a combination of postural hypotension and a significant stenosis of the left ICA.