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Capsular Warning Syndrome - A Case Series and Discussion on Management Dilemmas
Uma Sundar1, Pramod Darole2, Ashank Bansal3
1Professor, Medicine, LTMMCH, Mumbai, Maharashtra; Corresponding Author.
The Journal of the Association of Physicians of India
|September 2, 2021
Summary
Capsular warning syndrome (CWS) involves recurrent, stereotypical transient ischemic attacks. Intravenous thrombolysis appears safe and effective for CWS, similar to acute ischemic stroke, followed by antiplatelet therapy.
Area of Science:
- Neurology
- Cerebrovascular Diseases
Background:
- Capsular warning syndrome (CWS) is characterized by recurrent, stereotypical transient ischemic attacks without cortical signs.
- A significant percentage of CWS patients develop infarcts, yet treatment guidelines are lacking.
- CWS is a lesser-known neurological entity requiring further investigation.
Purpose of the Study:
- To investigate the clinical characteristics, management, and outcomes of patients with suspected Capsular warning syndrome (CWS).
- To evaluate the safety and efficacy of intravenous thrombolysis in CWS patients.
- To contribute to the understanding and potential treatment strategies for CWS.
Main Methods:
- Retrospective study of 9 patients presenting with recurrent, stereotypical transient ischemic attacks suggestive of CWS over two years.
- Analysis of clinical data, neuroimaging (CT brain angiography), etiological investigations, management, and patient outcomes.
- Inclusion of patients who received intravenous thrombolysis with t-PA.
Main Results:
- Seven out of nine patients were under 40 years old, with pure motor syndrome being the most common presentation.
- Neurologic deficits ranged from 5 to 20 minutes with complete recovery between episodes.
- Five patients received IV thrombolysis; one worsened, while four improved clinically.
Conclusions:
- The pathogenesis and management of CWS remain unclear, posing a treatment dilemma.
- Intravenous thrombolysis may be a safe option for CWS, similar to acute ischemic stroke.
- Antiplatelet agents are recommended following thrombolysis for CWS patients.
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