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

Abstract

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.

Capsular warning syndrome and its clinical awareness and therapeutic approach: two case reports and a systematic review of the literature

“…Intravenous thrombolysis, oral anticoagulants, and vasopressors have been used to treat patients with CWS. There has not been an agreement on which treatment is the best and regardless of the various available ones being used, we still do not have enough evidence to see if these affect the natural history of CWS ( 1 , 2 , 6 ). In the present series, the first patient presented six recurrent events of right-sided hemiparesis before developing an ischemic stroke despite receiving antiplatelet drugs and oral anticoagulants.…”

“…A total of 51 patients received rt-PA treatment; thrombolysis alone was applied in seven patients, and 44 patients received rt-PA associated with other drugs, such as DAT ( 18 ), DAT plus ACT ( 2 ), and SAT ( 3 ) without specified antiplatelets ( 6 ) and with ACT ( 1 ). From the 51 patients treated with rt-PA alone or combined, 3 and 22 showed recovery, respectively ( Figure 4B ).…”

“…Clinical awareness is of utmost importance due to its high risk of developing ischemic strokes with a permanent neurological deficit ( 6 , 7 ). The 7-day stroke risk following a CWS is as high as 60% ( 8 ), with the majority of strokes happening within the first 48 h ( 7 ).…”