Background <p>Limb-shaking transient ischemic attack (LS-TIA) is a special type of TIA, typically attributed to atherosclerotic carotid stenosis and only rarely associated with moyamoya angiopathy. The manifestation of LS-TIA can sometimes lead to a misdiagnosis as epileptic seizures.</p> Case presentation <p>This report presented a young female patient who was admitted with a two-month history of recurrent left upper limb tremors, followed by the sudden onset of limb weakness. Clinical evaluation confirmed LS-TIA, which subsequently progressed to acute cerebral infarction. Digital subtraction angiography revealed severe stenosis of the right internal carotid artery and occlusion of the right middle cerebral artery, aligning with symptoms of suspected moyamoya disease. Antiplatelet drug treatment was ineffective, while the symptoms were relieved after surgical treatment.</p> Conclusion <p>This case highlights the need to consider LS-TIA in patients presenting with episodic limb tremors, particularly when standard etiologies are absent. Early recognition through neuroimaging and electroencephalography, along with timely intervention, is critical for preventing stroke and improving clinical outcomes.</p>