Internal carotid artery occlusion related to poorly controlled rheumatoid arthritis presenting with continuous hand shaking : A case report and literature review
Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc..
RATIONALE: Limb-shaking syndrome is a special manifestation of transient ischemic attack, resulting from internal carotid artery (ICA) occlusion. Extra-articular manifestations of rheumatoid arthritis (RA) are likely to occur in patients with severe or active RA. RA may accelerate atherosclerotic processes through inflammation. Here, we present a case of ICA occlusion related to poorly controlled RA that presented with continuous hand shaking.
PATIENT CONCERNS: A 73-year-old man with a history of poorly controlled RA developed total occlusion of the right ICA in recent 4 months. He presented with 2 days of continuous and rhythmic left-hand shaking before admission.
DIAGNOSIS: The patient was suspected to have transient ischemic attack resulting from ICA occlusion.
INTERVENTIONS: Antiplatelets and antiepileptic drugs were used for continuous nonepileptic focal myoclonus. A disease-modifying antirheumatic drug-based regimen for RA was developed to prevent further atherosclerosis.
OUTCOMES: Following the initial intervention, continuous hand shaking subsided on hospital day 7. Prednisolone was titrated as an active RA control. At the 6-month follow-up visit, neither painful wrist swelling nor recurrent shaking of the hand was noted.
LESSONS: Continuous hand shaking (nonepileptic focal myoclonus) can be the initial presentation of ICA occlusion in patients with poorly controlled RA. Every patient with RA should be treated aggressively with anti-rheumatic agents since RA is an independent risk factor for stroke. Additionally, every patient with RA should be surveyed for ICA stenosis, especially in those with poor control.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:101 |
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| Enthalten in: |
Medicine - 101(2022), 9 vom: 04. März, Seite e29001 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Chien, Ching-Fang [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 22.03.2022 Date Revised 03.01.2023 published: Print Citation Status MEDLINE |
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| doi: |
10.1097/MD.0000000000029001 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM337752737 |
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| 100 | 1 | |a Chien, Ching-Fang |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Internal carotid artery occlusion related to poorly controlled rheumatoid arthritis presenting with continuous hand shaking |b A case report and literature review |
| 264 | 1 | |c 2022 | |
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| 500 | |a Date Completed 22.03.2022 | ||
| 500 | |a Date Revised 03.01.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc. | ||
| 520 | |a RATIONALE: Limb-shaking syndrome is a special manifestation of transient ischemic attack, resulting from internal carotid artery (ICA) occlusion. Extra-articular manifestations of rheumatoid arthritis (RA) are likely to occur in patients with severe or active RA. RA may accelerate atherosclerotic processes through inflammation. Here, we present a case of ICA occlusion related to poorly controlled RA that presented with continuous hand shaking | ||
| 520 | |a PATIENT CONCERNS: A 73-year-old man with a history of poorly controlled RA developed total occlusion of the right ICA in recent 4 months. He presented with 2 days of continuous and rhythmic left-hand shaking before admission | ||
| 520 | |a DIAGNOSIS: The patient was suspected to have transient ischemic attack resulting from ICA occlusion | ||
| 520 | |a INTERVENTIONS: Antiplatelets and antiepileptic drugs were used for continuous nonepileptic focal myoclonus. A disease-modifying antirheumatic drug-based regimen for RA was developed to prevent further atherosclerosis | ||
| 520 | |a OUTCOMES: Following the initial intervention, continuous hand shaking subsided on hospital day 7. Prednisolone was titrated as an active RA control. At the 6-month follow-up visit, neither painful wrist swelling nor recurrent shaking of the hand was noted | ||
| 520 | |a LESSONS: Continuous hand shaking (nonepileptic focal myoclonus) can be the initial presentation of ICA occlusion in patients with poorly controlled RA. Every patient with RA should be treated aggressively with anti-rheumatic agents since RA is an independent risk factor for stroke. Additionally, every patient with RA should be surveyed for ICA stenosis, especially in those with poor control | ||
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| 700 | 1 | |a Wu, Meng-Ni |e verfasserin |4 aut | |
| 700 | 1 | |a Lai, Chiou-Lian |e verfasserin |4 aut | |
| 700 | 1 | |a Liou, Li-Min |e verfasserin |4 aut | |
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