Abstract
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.
Highlights
Capsular warning syndrome (CWS) was a rare clinical syndrome, which was defined as recurrent transient lacunar syndromes
We retrospectively reviewed 4213 patients, among them, 3370 had acute ischemic stroke and, 843 subjects with transient ischemic attacks (TIA), which were manually reviewed to identify patients affected by CWS
The most common risk factors were hypertension and dyslipidemia, 52 patients had a history of hypertension, 47 had a history of hyperlipidemia, 27 had a history of diabetes, patients smoke,24 current alcohol drinking. patients were treated with rt-PA, 45 patients were treated with other medical treatment, among them, 30 patients were treated with 300 mg of clopidogrel followed by 75 mg/day and aspirin (100 mg/day) and high-dose atorvastatin (40 mg/day), 15 patients were treated with aspirin (200mg/day) and atorvastatin (40 mg/day).Clinical characteristics of CWS patients were showed in table 1
Summary
Capsular warning syndrome (CWS) was a rare clinical syndrome, which was defined as recurrent transient lacunar syndromes. The purpose of this study was to discuss the clinical characteristics, treatment and prognosis of the CWS. CWS was a rare clinical syndrome, which presented repeated stereotyped episodes of transient ischemic attacks (TIA), and increased the risk of permanent infarction, there had not been many large studies. Previous study showed that the incidence was about 1.5% among patients with TIAs [2].the exact pathophysiological mechanism of CWS was not clear, and different treatments had been suggested, such as blood pressure control [4,5], anticoagulation [6], double antiplatelet therapy [7,8], single antiplatelet , and thrombolytic agent [8-114], but the best clinical management of these patients remain controversial.
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