Administration of recombinant tissue plasminogen activator to a case of cerebral infarction in the setting of painless aortic dissection.

Miller Fisher first described a temporary limb shaking syndrome (LSS) associated with carotid stenosis in 1962; since then, the diagnosis has been reported regularly though only 48 cases have been recorded so far as per our review and rather than being rare, it seems to be a misrecognized syndrome.[1] However bilateral shaking of lower extremities is a very rare presentation.[2] The clinical features of LSS comprise a group of rhythmic or arrhythmic involuntary hyperkinesias affecting the hand, arm, leg, hand-arm, or hand-arm-leg unilaterally. They can be very easily be mistaken for focal seizures though there is no jacksonian march and there is no involvement of the face, as what happened in our patient. Patients describe these movements as shaking, jerking, twitching, or trembling. Associated symptoms may include ataxia, myoclonus, dystonic limb posturing, and Parkinsonism. [3] These symptoms are often brought out by postural change and at times relieved by sitting or lying down.