Involuntary shaking of the arm and leg

Clinical history A 56-year-old man presented with a short episode of language problems followed by recurrent short-lasting attacks of a shaking right arm and leg with loss of sensation. These attacks occurred four to five times a day and had a sudden onset (no march) of symptoms. Most attacks occurred soon after rising from a chair or walking a few steps. Ten years ago, he had transient episodes of dysarthric speech problems and a significant right carotid stenosis was found and he underwent carotid endarterectomy. A further medical history revealed an aortic aneurysm for which a bifurcation graft was placed, rheumatoid arthritis, hypertension, and hypercholesterolemia. Examination Neurological examination revealed no focal deficits. His blood pressure was 145/85 mmHg in the supine position and 135/90 mmHg after two minutes in the upright position. The carotid artery pulse was present on the right and absent on the left side, and no murmurs were heard. Neurological scores: NIHSS 0, mRS 1.