Emergency Cases Northwest Group

020 Shake a Leg

Situation

A 65 yr old man was diagnosed with TIA, he actually had a brain metastasis.

Background

The patient described his left leg shaking uncontrollably for 5 minutes. No other symptoms and examination was normal. TIA diagnosed, at that time protocol was TIA clinic referral without a CT brain. He returned the next day to ED by mistake where CT head showed a large brain met [cxr suspicious for lung ca – he was a smoker]

Assessment

He was misdiagnosed with a TIA because he was labelled as having leg weakness rather than leg shaking. The met was likely causing cerebral oedema and thus a form of partial, focal seizure of just one limb.

Recommendation

If a patient describes unilateral limb shaking, even if transient, give serious thought to a diagnosis of SOL.



PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group