Loading dose of clopidogrel in combination with other antithrombotic therapy for capsular warning syndrome

Area of Science:

• Neurology
• Vascular Neurology
• Neuroimaging

Background:

• Capsular warning syndrome (CWS) is characterized by recurrent, stereotyped transient ischemic attacks (TIAs).
• TIAs in CWS often manifest as sudden-onset motor or sensory deficits.
• Identifying effective treatments for CWS is crucial for preventing stroke.

Observation:

• A 66-year-old male presented with recurrent TIAs, including dysarthria and left hemiparesis.
• Magnetic resonance imaging revealed a lesion in the right putamen extending to the corona radiata, consistent with CWS.
• Standard antithrombotic therapy, including aspirin, was initially ineffective in preventing recurrent TIAs.

Findings:

• A loading dose of clopidogrel was added to the existing antithrombotic regimen.
• Following the addition of clopidogrel, no further TIAs were observed in the patient.
• This suggests a potential benefit of clopidogrel loading dose in managing CWS.

Implications:

• A loading dose of clopidogrel, in conjunction with other antithrombotic agents, may represent an effective therapeutic strategy for CWS.
• This approach could help prevent recurrent TIAs and reduce the risk of stroke in CWS patients.
• Further research is warranted to confirm the efficacy and optimal use of clopidogrel in CWS management.