Heterogeneity of the capsular warning syndrome; experiences of a single centre

Capsular warning syndrome (CWS) is characterized by recurrent episodes of TIAs within a 24-hour, affecting at least two regions of the face, upper and/or lower extremities, and the absence of cortical symptoms.

CWS accounts for small percentage of TIAs. However, it is associated with a higher risk of stroke and permanent neurological deficits. In this article, we present the findings, treatment and prognosis of CWS.

This study reviewed the data of patients with cerebral small vessel disease. The clinical findings, the number and duration of CWS attacks, and treatments were noted. The NIHSS and the 3-month-mRS of the patients were evaluated to determine their prognosis.

A total of 27 CWS cases were included, with an average age of 71.25 and 74.1% male. The most common lesion location was the internal capsule(51.8%), followed by the corona radiata. Dual antiplatelet therapy was the preference in 81.5% of patients. It was observed that the mean 3-month-mRS was 3.60 in the anticoagulation group and 0.90 in the antiplatelet group.

Our study highlights important information regarding lesion location, attack durations and treatment and shows that especially dual antiplatelet therapy is more effective in preventing permanent neurological deficits and CWS attacks.