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Capsular warning syndrome mimicking a jacksonian sensory march

Christina M Caporale1, Francesca Notturno, Massimo Caulo

  • 1Department of Human Motor Sciences and Neurodegenerative Diseases Unit, Institute of Aging (Ce.S.I) University G. d'Annunzio Foundation, Chieti-Pescara, Italy.

Journal of the Neurological Sciences
|August 12, 2009
PubMed

Insights

Transient sensory symptoms preceding a stroke may indicate a capsular warning syndrome, not epilepsy. This case highlights distinguishing these neurological events for timely intervention and stroke prevention.

Area of Science:

  • Neurology
  • Neuroscience
  • Stroke Medicine

Background:

  • A patient with a history of meningioma surgery presented with recurrent sensory disturbances.
  • Initial diagnosis considered somatosensory seizures with Jacksonian march.

Observation:

  • The patient experienced stereotyped, ascending paresthesias from foot to hand.
  • Following these episodes, the patient developed right hemiplegia, hemianesthesia, and dysarthria.
  • An infarct in the left posterior capsular limb was identified as the cause.

Findings:

  • The sensory episodes were re-evaluated as a potential capsular warning syndrome.
  • Factors supporting this included the frontal lesion location, lack of motor symptoms, negative EEGs, and absence of recurrence post-stroke.
  • Progressive ischemic depolarization recruiting sensory fibers in the posterior capsular limb can mimic Jacksonian march.

Implications:

  • Differentiating capsular warning syndrome from epilepsy is crucial for appropriate management.
  • Prompt recognition of these sensory warning signs can lead to earlier stroke intervention.
  • Understanding the pathophysiology of sensory symptoms in stroke is vital for accurate diagnosis.

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