Capsular warning syndrome as a manifestation of isolated middle cerebral artery dissection in a Latin American patient

Bonardo, Pablo; Bandeo, Lucrecia; Chertcoff, Aníbal; Pantiú, Fátima; Masenga, Gustavo

doi:10.1177/1747493017701155

“…The presented cases show how the diagnosis and management of middle cerebral artery dissections might be challenging. At the onset, symptoms might be heterogeneous in their severity and develop in an acute, subacute, or fluctuating fashion [ 8 ]. Medical treatment should be evaluated on an individual basis since the pathophysiology in this setting is complex and might encompass multiple mechanisms at once, while the risk of hemorrhagic complications might pivot on several factors, although a longitudinal and transmural extension of the vessel wall rupture is considered the most relevant [ 1 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Middle Cerebral Artery Dissection: A Report of Two Cases With Treatments and Outcomes

Papiri¹,

Bruni²,

Puca³

et al. 2023

Cureus

0

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In the present report, we describe two cases of right-sided M1 segment middle cerebral artery dissection in a 51-year-old Asian female and in a 28-year-old Caucasian male patient with no previous history of ischemic stroke or known intracranial atherosclerosis presenting with acute unilateral headache progressing to severe multifocal hemispheric infarction with nearly complete one-sided motor paralysis. In both patients, a middle cerebral artery dissection was detected on angiography; they were given exclusively medical therapy: patient 1 was not eligible to reperfusive therapies and was treated with a three-month course of acetylsalicylic acid and clopidogrel combined with low-dose enoxaparin, while patient 2 was initially treated with intravenous alteplase with no hemorrhagic complications and was later shifted to single antiplatelet therapy. Despite an initial worsening of clinical severity and an extensive ischemic lesion in both patients, neurologic function improved over time, eventually allowing recovery of unaided gait. Therefore, in the absence of signs of hemorrhage, intravenous thrombolysis or dual antiplatelet regimens could be considered in strokes related to middle cerebral artery dissection.

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“…Despite various treatments being available and used, it was unclear whether these treatments alter the natural course of the syndrome. Intravenous thrombolysis, double antiplatelet therapy, single antiplatelet therapy,anticoagulants, vasopressors had been used to treat patients with CWS [1,4,5,7,[9][10][11][12][13][18][19][20][21][22][23][24][25][26], it remains uncertain whether any of these therapies were able to change the progression of the syndrome. There was no strong evidence for the efficacy of anticoagulant therapy in the acute phase of CWS.…”

Section: Discussionmentioning

confidence: 99%

Capsular Warning Syndrome: Clinical Analysis and Treatment

He

¹

,

Xu²,

Wang

³

et al. 2019

Preprint

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Background: Capsular warning syndrome (CWS) was a rare clinical syndrome, which was defined as recurrent transient lacunar syndromes. The mechanism and clinical management of CWS were not clear. The purpose of this study was to discuss the clinical characteristics, treatment and prognosis of the CWS. Methods: This was a multicenter retrospective study that involved three medical centers, we collected clinical data from patients with CWS between January 2013 and December 2018. We analyzed the clinical characteristics of the CWS. Patients with CWS were divided into two groups: rt-PA and no rt-PA groups. We analyzed the therapeutic effects and prognosis between different groups. Results: This study included 72 patients, 27 in rt-PA group, 45 in no rt-PA group, hypertension and dyslipidemia were the most common risk factors. The mean number of episodes before an irreversible neurological impairment or the symptoms completely disappeared was 5 times(3-11). 59 (81.94%) patients had acute infarction lesions on the diffusion weighted imaging (DWI). The most common infarct location was the internal capsule (76.38%,55), followed by the thalamus and pons. The difference in therapeutic effects between rt-PA, single and double antiplatelet groups was not significant(P>0.05). A good prognosis was observed in 61 (84.72%) patients at 3-month, 23 (23/27, 85.19%) patients in rt-PA group and 38 (38/45,84.44%) patients in no rt-PA group(P>0.05). After 3 months of follow-up, 2 patients had recurrent ischemic stroke. Conclusions: The most effective treatment of CWS remains unclear. Despite the high incidence of infarction in CWS patients, more than 80% patients had favorable functional prognosis

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“…Despite various treatments being available and used, it was unclear whether these treatments alter the natural course of the syndrome. Intravenous thrombolysis, double antiplatelet therapy, single antiplatelet therapy, anticoagulants, vasopressors had been used to treat patients with CWS [1,4,5,7,[9][10][11][12][13][20][21][22][23][24][25][26][27][28], it remains uncertain whether any of these therapies were able to change the progression of the syndrome. There was no strong evidence for the efficacy of anticoagulant therapy in the acute phase of CWS.…”

Section: Discussionmentioning

confidence: 99%

Capsular Warning Syndrome: Clinical Analysis and Treatment

He

¹

,

Xu²,

Wang

³

et al. 2019

Preprint

0

View full text Add to dashboard Cite

Background: Capsular warning syndrome (CWS) was a rare clinical syndrome, which was defined as recurrent transient lacunar syndromes. The mechanism and clinical management of CWS were not clear. The purpose of this study was to discuss the clinical characteristics, treatment and prognosis of the CWS. Methods: This was a multicenter retrospective study that involved three medical centers, we collected clinical data from patients with CWS between January 2013 and December 2018. We analyzed the clinical characteristics of the CWS. Patients with CWS were divided into two groups: rt-PA and no rt-PA groups. We analyzed the therapeutic effects and prognosis between different groups. Results: This study included 72 patients, 27 in rt-PA group, 45 in no rt-PA group, hypertension and dyslipidemia were the most common risk factors. The mean number of episodes before an irreversible neurological impairment or the symptoms completely disappeared was 5 times(3-11). 59 (81.94%) patients had acute infarction lesions on the diffusion weighted imaging (DWI). The most common infarct location was the internal capsule (76.38%,55), followed by the thalamus and pons. The difference in therapeutic effects between rt-PA, single and double antiplatelet groups was not significant(P>0.05). A good prognosis was observed in 61 (84.72%) patients at 3-month, 23 (23/27, 85.19%) patients in rt-PA group and 38 (38/45,84.44%) patients in no rt-PA group(P>0.05). After 3 months of follow-up, 2 patients had recurrent ischemic stroke. Conclusions: The most effective treatment of CWS remains unclear. Despite the high incidence of infarction in CWS patients, more than 80% patients had favorable functional prognosis

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Capsular warning syndrome as a manifestation of isolated middle cerebral artery dissection in a Latin American patient

Cited by 7 publications

References 5 publications

Middle Cerebral Artery Dissection: A Report of Two Cases With Treatments and Outcomes

Middle Cerebral Artery Dissection: A Report of Two Cases With Treatments and Outcomes

Capsular Warning Syndrome: Clinical Analysis and Treatment

Capsular Warning Syndrome: Clinical Analysis and Treatment

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