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Orthostatic‐Mediated Hypoperfusion in Limb‐Shaking Transient Ischemic Attack
Author(s) -
Khan Atiq,
Beletsky Vadim,
Kelley Roger,
Ehsan Tajammul
Publication year - 1999
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/jon19999143
Subject(s) - medicine , acetazolamide , orthostatic vital signs , transcranial doppler , perfusion , cardiology , middle cerebral artery , cerebral blood flow , occlusion , cerebral perfusion pressure , anesthesia , ischemia , blood pressure
In patients with severe carotid stenosis or total occlusion, episodic contralateral motor dysfunction is more likely related to cerebral hypoperfusion than epileptogenic activity. A man with orthostatic‐mediated right‐sided limb shaking was found to have total left internal carotid artery occlusion. There was prominent reduction of cerebrovascular reserve seen on single photon emission computed tomography (SPECT) performed with and without acetazolamide. During assumption of an upright position transcranial Doppler (TCD) revealed a marked attenuation of the left middle cerebral artery flow pattern not associated with changes during electroencephalographic monitoring, even after administration of acetazolamide. In this man, limb shaking episodes were attributed to hypoperfusion of the contralateral cerebral hemisphere, and not to epileptogenic activity.