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Capsular Serotyping of Streptococcus pneumoniae Using the Quellung Reaction
Published on: February 24, 2014
Capsular warning syndrome.
Vivek Nadarajan1, Tolu Adesina
1Department of Stroke, National Hospital for Neurology and Neurosurgery, London, UK. proust69@hotmail.com
BMJ Case Reports
|July 16, 2013
Summary
Capsular warning syndrome presents with transient neurological deficits. A case study reveals a pontine infarct, not the typical capsular infarct, highlighting varied stroke locations and treatment uncertainties.
Area of Science:
- Neurology
- Neuroscience
- Stroke Medicine
Background:
- Capsular warning syndrome (CWS) is a transient ischemic attack (TIA) characterized by recurrent, stereotyped neurological deficits, often preceding a major stroke.
- The typical presentation involves sudden onset hemiparesis or hemisensory loss, classically attributed to lacunar infarcts in the internal capsule.
Observation:
- A 72-year-old male presented with fluctuating right-sided weakness and numbness, consistent with CWS.
- Despite dual antiplatelet therapy, his symptoms progressed, indicating a need for further investigation.
- Neuroimaging revealed a pontine infarct, an atypical location for CWS.
Findings:
- This case challenges the classical understanding of CWS, demonstrating that infarcts can occur in locations other than the internal capsule.
- The pontine infarct in this CWS presentation suggests broader pathophysiological mechanisms may be involved.
- The patient's persistent symptoms despite standard antiplatelet therapy underscore treatment complexities.
Implications:
- This case highlights the importance of considering diverse infarct locations in patients presenting with CWS.
- It emphasizes the need for comprehensive neuroimaging to confirm the precise site of cerebrovascular events.
- Further research is warranted to clarify the pathophysiology and optimize treatment strategies for CWS to prevent completed strokes.
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