The article of Baumgartner and Baumgartner entitled “Vasomotor reactivity is exhausted in transient ischaemic attacks with limb shaking”1 provides interesting new information regarding the nature of involuntary limb movements contralateral to haemodynamic failure from severe carotid artery occlusive disease. The authors evoke an “exhausted cerebral vasoreactivity in the hemispheres opposite the involuntary limb movements”. In their report, involuntary movements affected only the limbs, and displayed no tonic contraction, tonic-clonic jerking, or Jacksonian march and no epileptic activity during or between the attacks. These findings led the authors to strongly argue against seizures as the cause of limb shaking in these transient ischaemic events.

In contradistinction, a 72 year old right handed man was admitted to our hospital with a 3 month history of episodic weakness and numbness of the right arm. The patient then had six discrete stereotypic episodes of right arm weakness and clumsiness that were also associated with …

Dr Ralf W Baumgartner, Neurologische Klinik, Frauenklinikstrase 26, CH-8091 Zürich, Switzerland. Telephone 0041 1 255 56 86; fax 0041 1 255 43 80; emailStrusb{at}neurol.unizh.ch

Dr Ralf W Baumgartner, Neurologische Klinik, Frauenklinikstrase 26, CH-8091 Zürich, Switzerland. Telephone 0041 1 255 56 86; fax 0041 1 255 43 80; emailStrusb{at}neurol.unizh.ch