Limb shaking is involuntary, rhythmical or dysrhythmical, transient, and usually coarse trembling or shaking of upper or lower extremities. Described in this report is a 47-year-old male patient who presented with sudden onset left-sided paresthesias and weakness. He had a similar episode with shaking movements of left arm followed by transient weakness and paresthesias 1 month before presentation. He had multiple acute and subacute infarctions on cranial magnetic resonance imaging (MRI). Cerebral digital subtraction angiography (DSA) revealed calibration changes and irregularity of the right internal carotid artery compatible with dissection and oral anticoagulant therapy was administered. The patient was followed for 6 months under effective oral anticoagulant therapy without appearance of any new symptoms. Limb shaking is a symptom of carotid artery disease (CAD) that can lead to severe cerebral infarction. It is important to recognize this unusual symptom in order to begin appropriate treatment of the ischemic event.