Spontaneous middle cerebral arterial dissection presented with limb shaking.

Middle cerebral artery dissection (MCAD) is a rare cause for ischemic stroke and is often associated with headache and hemispheric symptoms. In the present report, limb shaking is found to be a major symptom of spontaneous MCAD in a young male. The diagnosis of MCAD is based on the intramural hematoma directly visualized in MR T2-weighted images and supported by serial evolution of transcranial doppler sonography. This presentation suggests that limb shaking can be a symptom of severe intracranial carotid occlusive disease.