A rare presentation of unilateral carotid rete mirabile (RM) in a 70-year-old male manifesting as limb-shaking transient ischemic attacks, a disorder typically associated with carotid artery stenosis. The patient experienced recurrent left-sided limb shaking and numbness, with angiography revealing an anomalous microarterial collateral network replacing the right internal carotid artery's cavernous segment, indicative of RM. Differential diagnoses included recanalization following occlusion, arteriovenous malformation, with carotid canal dysplasia on computed tomography supporting the RM diagnosis. The patient's management involved antiplatelet therapy and lifestyle changes, following which he reported no further cerebrovascular events. This case underscores the importance of considering RM in differential diagnoses of limb-shaking transient ischemic attack and suggests conservative management as a favorable approach.
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