Abstract
A 72-year-old man was admitted with a chief complaint of involuntary movement of the right arm and leg that had persisted for three weeks. Although chorea of the right arm and leg was observed, the patient had no other neurological abnormalities. SPECT revealed reduced blood flow from the left frontal lobe to the parietal lobe, but no abnormal findings were observed on brain images (brain CT, MRI) or electroencephalogram. Following admission, the involuntary movement spontaneously resolved and disappeared, and the patient was subsequently discharged. However, two days later, he was readmitted due to the onset of aphasia and paralysis of the right arm and leg. Brain MRI showed acute cerebral infarcts dispersed in the left basal ganglia, frontal lobe, and temporal lobe, while MRA revealed occlusion of the left internal carotid artery. Although no clear abnormalities had been detected on imaging tests and electroencephalogram at the initial admission, based on the patient’s course, the involuntary movement of the right arm and leg that had been initially observed was thought to have been limb shaking (LS) associated with hemodynamic factors resulting from the lesion in the left internal carotid artery. As LS generally has a hemodynamic mechanism, symptoms often manifest transiently and rarely persist for a few weeks, as in the present case. If we had initially suspected a cerebrovascular disorder at the first medical examination, we might have prevented cerebral infarction. Therefore, we consider this to be an important instructive case.
