Intravenous thrombolysis with recombinant tissue plasminogen activator in vascular warning syndromes

Clinical Characteristics and Outcome of the Capsular Warning Syndrome: A Multicenter Study

“…Thus, it seems that the appropriateness of the term ‘Capsular Warning Syndrome’ should be reconsidered. Perhaps ‘Vascular Warning Syndrome’ or ‘Stroke Warning Syndrome’, terms used in recent studies, may be more appropriate as CWS can occur from a lesion anywhere in the corticospinal tract (4,6).…”

“…Thus, several aspects regarding the clinical management of these patients remain controversial. Additionally, whether the outcome of CWS is modified by thrombolysis is uncertain, and few studies have reported the short-term clinical outcomes of these patients who were treated with recombinant tissue plasminogen activator (rtPA) (4,6). Finally, there are no reports regarding long-term stroke and other vascular recurrences in CWS patients.…”

rt-PA with Antithrombotic Therapies in a Case with Capsular Warning Syndrome

“…A recent study showed that infarct locations of CWS vary; 50% of CWS patients have infarctions in the internal capsule, but the other half have infarctions in other locations ( 14 ). As such, some researchers and clinicians have suggested that the term “capsular warning syndrome” might not be adequate, and “vascular warning syndrome” or “stroke warning syndrome” has been used in some recent reports ( 8 , 14 , 15 ). Our patient had recurrent stereotyped episodes of TIAs, and MRI showed acute cerebral infarctions in the internal capsule to corona radiata, so we diagnosed her with CWS.…”

“…About 40% to 60% of CWS patients develop a cerebral infarction within 10 days ( 1 , 2 ). Many different treatments have been proposed, such as multi-target antiplatelet therapies ( 3 - 6 ), a loading dose of clopidogrel ( 4 , 5 ), and recombinant tissue plasminogen activator (rt-PA) ( 7 - 15 ), but no effective therapy has yet been established. In addition, the efficacy of rt-PA on the outcome of CWS has not been determined.…”