Limb-shaking TIA: An asterixis

Limb shaking is a well-known symptom of TIA associated with the steno-occlusion of the internal carotid artery (ICA).1 It has been shown that the symptom is closely associated with hemodynamic impairment in the anterior circulation.2 However, the pathogenic nature of the limb-shaking symptom remains unclear. We describe a patient presenting with limb-shaking TIA caused by severe distal ICA stenosis, which turned out to be an asterixis electrophysiologically using surface EMG.