Capsular warning syndrome: The role of blood pressure

Ladeira, Filipa; Barbosa, Raquel; Viana-Baptista, Miguel

doi:10.1016/j.jns.2017.08.008

Cited by 10 publications

(9 citation statements)

References 7 publications

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“…ND hypertension was confirmed during the hospital stay through repeated BP measurements ≥24 h after symptom resolution, in order to exclude cases with transient BP elevation possibly related to compensatory mechanisms during the acute phase. We suggest that the lack of stabilizing effects of antihypertensive treatment could elicit blood pressure fluctuations [5, 12], potentially enhancing hypoperfusion of the penetrating artery. Terai et al [13] performed serial MRI during L symptoms disclosing penetrating artery hypoperfusion and a correspondence between thrombus development into the hypoperfused vessel and ultimate core infarction.…”

Section: Discussionmentioning

confidence: 99%

Capsular Warning Syndrome: Features, Risk Profile, and Prognosis in a Large Prospective TIA Cohort

et al. 2022

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Introduction: Features and prognosis of capsular warning syndrome (CWS) have been poorly investigated prospectively. Aims: The study aimed to characterize CWS clinical features, risk profile, short- and long-term prognosis, among a large TIA cohort. Methods: Prospective cohort study of consecutive TIAs was conducted from August 1, 2010, to December 31, 2017. Demographic and clinical characteristics, risk profile, primary (stroke and composite outcome) and secondary (TIA recurrence, cerebral hemorrhage, new onset atrial fibrillation) outcomes were compared between CWS, lacunar (L), and nonlacunar (NL) TIAs. Results: 1,035 patients (33 CWS, 189 L-TIAs, 813 NL-TIAs) were enrolled. Newly diagnosed (ND) hypertension, hypercholesterolemia, cigarette smoking, and leukoaraiosis were independent risk factors of CWS (p < 0.05). CWS showed the highest stroke (30.3% vs. 0.5% and 1.5% for L-TIAs and NL-TIAs, respectively) and composite outcome risk at follow-up (p < 0.001), but better 3-month post-stroke prognosis (mRS 0–2 90.0% vs. 36.8%; p = 0.002). CWS-related stroke mostly occurred <48 h (80.0%) and had a small vessel occlusion etiology (100%), affecting more often the internal capsule (60.0%). Dual antiplatelet therapy (DAPT) versus single antiplatelet therapy was associated with lower 3-month cumulative stroke incidence (12.5% vs. 57.1%; p = 0.010). Intravenous thrombolysis (IVT) showed similar 3-month efficacy and safety in strokes after TIAs groups (median mRS 0, IQR 0–1; p = 0.323). Conclusions: CWS is associated with higher stroke risk and better functional prognosis than L- and NL-TIAs. CWS risk profile is consistent with severe small vessel disease, and ND hypertension could represent a major risk factor. DAPT and IVT seem effective and safe in preventing and treating stroke following CWS.

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Section: Discussionmentioning

confidence: 99%

Capsular Warning Syndrome: Features, Risk Profile, and Prognosis in a Large Prospective TIA Cohort

et al. 2022

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“…The exact pathophysiological mechanism of CWS is still remain unknown. There were studies that relate co-morbidities with hypertension, diabetes, dyslipidaemia, cigarette smoking and other stroke risk factors to developing CWS, which suggest that atherosclerosis of the small-penetrating arteries may be involved in the pathogenesis [ 4 , 5 ]. There was also some speculation that CWS was associated with small-penetrating arterial disease where intermittent hemodynamic changes due to structural arterial changes or hypertension leading to ischaemia [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

‘Crescendo transient ischemic attack’—an uncommon presentation of a very common disease: a case report on capsular warning syndrome

Payus

Ibrahim

Sheaker

et al. 2022

Oxford Medical Case Reports

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Capsular warning syndrome is a rare presentation of transient ischaemic attack, which described as recurrent episodes of motor and/or sensory deficits which typically sparring the cortical function. It has a significant risk to progress into a massive stroke with permanent disability, thus important to be recognise early. Here, we report a middle-age gentleman with no known medical illness presented with eight episodes of transient ischaemic attack within the span of 24 h. He was treated with double anti-platelet for 21 days and was not subjected to thrombolysis at time of presentation because it was outside the window period of 4.5 h, and has fully recovered after each episode. The purpose of this case report is to share the uncommon clinical presentation of transient ischaemic attack, which is still not fully understood and warrant more studies especially on the treatment that can affect the progression of the disease.

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“…Studies have confirmed that hypertension, diabetes, dyslipidemia, smoking and other common stroke risk factors are correlated to CWS, which might suggest that atherosclerosis may be involved in the pathogenesis of CWS [1, 19–21]. Some authors have speculated that CWS was most likely to be ischemia due to in situ small-penetrating vessel disease, while some authors have considered that intermittent hemodynamic changes secondary to structural arterial changes or hypertension might be the most likely mechanism of CWS [1, 22]. In the present study, the cranial CTA revealed that vascular stenosis or dissection was not found in patients, while echocardiography did not reveal any cardiac sources.…”

Section: Discussionmentioning

confidence: 99%

Capsular warning syndrome: clinical analysis and treatment

Wang

et al. 2019

BMC Neurol

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BackgroundCapsular warning syndrome (CWS) is a rare clinical syndrome, which is defined as a recurrent transient lacunar syndrome. The mechanism and clinical management of CWS remain unclear. The aim of the study was to discuss the clinical characteristics of CWS and evaluate the different outcome between rt-PA and no rt-PA therapy.MethodsThe present multicenter retrospective study involved three medical centers, and the clinical data were collected from patients with CWS between January 2013 and December 2018. The clinical characteristics of CWS were analyzed. Patients were divided into two groups: rt-PA and no rt-PA groups. The therapeutic effects and prognosis of these two groups were analyzed. A good prognosis was defined as 3-month modified Rankin Scale (mRS) ≤ 2.ResultsOur study included 72 patients, 27 patients were assigned to rt-PA group, 45 in no rt-PA group. Hypertension and dyslipidemia were the most common risk factors. The mean number of episodes before irreversible neurological impairment or the symptoms completely disappeared was five times (range: 3–11 times). A total of 58 (80.55%) patients had acute infarction lesions on the diffusion weighted imaging (DWI). The most common infarct location was the internal capsule (41,70.69%), followed by the thalamus and pons. The difference in therapeutic effects between the rt-PA, single and double antiplatelet groups was not statistically significant (P > 0.05). A good prognosis was observed in 61 (84.72%) patients after 3 months, in which 23 (23/27, 85.19%) patients were from the rt-PA group and 38 (38/45,84.44%) patients were from the no rt-PA group (P > 0.05). After 3 months of follow-up, two patients had recurrent ischemic stroke.ConclusionThe most effective treatment of CWS remains unclear. Intravenous thrombolysis is safe for CWS patients. Regardless of the high frequency of infarction in CWS patients, more than 80% patients had a favorable functional prognosis.

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Capsular warning syndrome: The role of blood pressure

Cited by 10 publications

References 7 publications

Capsular Warning Syndrome: Features, Risk Profile, and Prognosis in a Large Prospective TIA Cohort

Capsular Warning Syndrome: Features, Risk Profile, and Prognosis in a Large Prospective TIA Cohort

‘Crescendo transient ischemic attack’—an uncommon presentation of a very common disease: a case report on capsular warning syndrome

Capsular warning syndrome: clinical analysis and treatment

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