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Capsular warning syndrome: report of a case
1Department of Neurology, Taipei Medical University-Wan Fang Hospital, Taiwan.
Acta Neurologica Taiwanica
|March 14, 2009
Summary
Capsular warning syndrome (CWS) involves recurrent transient ischemic attacks without cortical signs, posing a high risk for stroke. This case highlights anterior choroidal artery territory involvement and potential urokinase treatment effects.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Capsular warning syndrome (CWS) presents as recurrent, stereotypical transient ischemic attacks (TIAs) without cortical symptoms.
- CWS is associated with a significant risk of subsequent capsular infarction, often due to hemodynamic changes in small penetrating vessels.
- Current treatment strategies for CWS remain controversial and lack proven efficacy.
Observation:
- A 66-year-old male experienced 15 stereotypical TIAs over four days.
- Diffusion-weighted imaging revealed abnormalities in the left lateral thalamus, posterior globus pallidus, and posterior corona radiata.
- The internal capsule was notably spared, suggesting involvement of the anterior choroidal artery territory.
Findings:
- The neuroimaging findings support the hypothesis of ischemia within the anterior choroidal artery's vascular territory.
- The patient's TIA pattern demonstrated changes following the administration of intravenous urokinase.
- This case provides specific imaging correlation for CWS, implicating the anterior choroidal artery.
Implications:
- This case expands the understanding of CWS pathophysiology and its neuroimaging correlates.
- It suggests a potential role for anterior choroidal artery territory evaluation in CWS diagnosis.
- The observed response to urokinase warrants further investigation into its therapeutic potential for CWS.
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