Transient ischemic attack presenting as recurrent migratory numbness by seconds: a rare case confirmed by transcranial D
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CASE REPORT
Open Access
Transient ischemic attack presenting as recurrent migratory numbness by seconds: a rare case confirmed by transcranial Doppler micro-emboli monitoring Xianyue Liu, Ke Han, Mingyi Hu, Huanquan Liao and Qinghua Hou*
Abstract Background: Transient ischemic attack (TIA) is a brief episode of cerebral ischemia. However, if a symptom is not presented as drop attack or hemiplegia, and alarming to the patient and the physician, how short of a symptom duration would raise the concern of a physician for TIA? It will be more complicated if the location of the neurological deficit is vagrant. This report highlights a rare TIA case which presented a very short duration of migratory patchy distribution numbness. Case presentation: A middle-aged gentleman was presented with recurrent patchy distribution numbness on the right side of the body for 2 months, with the episode lasting as short as about 10 s. The location of the numbness was erratic and migratory. Magnetic resonance angiography (MRA) revealed mild stenosis on the left middle cerebral artery (MCA). Transcranial Doppler (TCD) micro-emboli monitoring detected positive micro-emboli signals (MES), leading to the confirmation of a TIA diagnosis. After a standard dual antiplatelet treatment combined with enhanced lipid reduction therapy with statins, MES disappeared on dynamic TCD emboli monitoring, and no more episodes of TIA have been noticed on the follow-ups. Conclusion: TIA caused by micro-emboli can display as recurrent migratory neurological deficit within seconds. TCD micro-emboli monitoring is very helpful to differentiate this situation from TIA mimics with follow-ups, as well as to locate unstable plague. Keywords: Transient ischemic attack, Transcranial Doppler, Micro-embolic signals, Migratory numbness, Case report
Background TIA is a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction [1]. The symptom of a typical TIA case will vanish most likely within 1 h [2], usually 5 to 15 mins [3], but rare in several seconds. If the symptom duration is as short as usually unconsidered seconds and the location of the neurological deficit is vagrant, * Correspondence: [email protected] The Clinical Neuroscience Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China
the diagnosis of TIA is difficult to be established. We here report a rare case of TIA with repeated, migratory, rapidly-disappeared patchy distribution of numbness on one side of the body, which is confirmed by TCD microemboli monitoring.
Case presentation A 44-year-old man, accounting himself to be basically healthy except for smoking for more than 20 years, presented in the clinic. The major complaint of this gentleman for this visit is that he has continually experienced
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any med
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