An elderly man who repeatedly kicked the woman ahead of him while waiting in queue to board a flight
1. 69-year old Balu, while waiting to board a flight, started to repeatedly fling his right leg that hit the woman standing in front. The woman was shocked with this incident.
1. 69-year old Balu, while waiting to board a flight, started to repeatedly fling his right leg that hit the woman standing in front. The woman was shocked with this incident.
2. She was terribly upset and remarked-"just because boarding is delayed & you are restless, doesn't mean you can kick me like that. Moreover, you can't take advantage of you being older to me".
But Balu denied any wrongdoing and said the leg started shaking without his control.
But Balu denied any wrongdoing and said the leg started shaking without his control.
3. As soon as Balu landed in Hyderabad, he consulted a physician, who diagnosed focal motor #seizures (fits) and started him on anti-epileptic drugs (AEDs). Similar symptoms repeated after one month despite being on regular AEDs, and he was referred for my opinion.
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4. I reviewed his clinical details- he had no aura prior to these abnormal leg movements, no loss of consciousness, no tongue bite or lack of urinary control during these episodes- these ruled out seizures. These leg movements lasted only 1-2 minutes.
The diagnosis was obvious.
The diagnosis was obvious.
5. Mr Balu's diagnosis was limb-shaking transient ischemic attacks (TIAs).
I asked him to get carotid doppler done, which showed 80% stenosis (narrowing) of left carotid artery. He was at a high risk of getting #stroke in future that could have left him paralyzed.
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I asked him to get carotid doppler done, which showed 80% stenosis (narrowing) of left carotid artery. He was at a high risk of getting #stroke in future that could have left him paralyzed.
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6. He was referred for left carotid revascularization procedure to reduce the risk of stroke (paralysis) in future. The procedure was uneventful and he was discharged in two days. He was started on blood thinners and statins. Medicines for high BP and diabetes were continued.
7. He remained well after the treatment and had no further episodes of involuntary shaking of legs.
*Take home message:
Involuntary shaking of leg for a few minutes could be a sign of brain ischemia (lack of blood flow to brain) due to narrowing of carotid artery.
*Take home message:
Involuntary shaking of leg for a few minutes could be a sign of brain ischemia (lack of blood flow to brain) due to narrowing of carotid artery.
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