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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
Summary
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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