Complete Recovery Of Symptoms Research Articles

Delayed spinal arachnoiditis with syringomyelia following aneurysmal subarachnoid haemorrhage: a case report with patient experience

Background and importanceSyringomyelia, or the formation of fluid-filled cysts within the spinal cord, associated with delayed spinal arachnoiditis is an uncommon complication of aneurysmal subarachnoid haemorrhage. To date, about 18 cases have been reported in medical literature, with just two reported in patients under the age of 35 years.Clinical presentationA 27-year-old female patient complained of sudden, severe headaches in the occipital region, nuchal rigidity, and drowsiness when she presented at our institution. A head computed tomography scan revealed intraventricular bleeding in the lateral and fourth ventricles with more extensive haemorrhaging in the frontal horns. A left posterior inferior cerebellar artery (PICA) aneurysm was confirmed via digital subtraction angiogram, and endovascular embolization was done. Two years later, the patient reported intense pain in the lower back along with symptoms suggestive of spinal cord compression. Spinal magnetic resonance imaging (MRI) showed spinal adhesions from C1 to L4, syringomyelia with some vasogenic oedema extending from T3 to T9 level, and a cyst in the lumbar region. Consequently, a right hemilaminectomy was performed along with microsurgical release of arachnoid adhesions and placement of a subdural drain. Radiological and symptomatic improvements were observed. Since then, the patient’s clinical condition has remained stable during the past three years of follow-up visits.ConclusionsLiterature on optimal treatment modalities and patient prognosis is scarce and debated. The time for symptom improvement depends on the level and extent of spinal cord involvement. Rehabilitation may be required for most patients, as complete symptomatic recovery may not be attainable.

Characteristics of Opsoclonus-Myoclonus Syndrome in Patients of the Largest Pediatric Hospital in Latin America

BackgroundOpsoclonus-myoclonus syndrome (OMS) is a rare neuroinflammatory disorder characterized by ataxia, opsoclonus, and myoclonus. Clinical diagnosis of OMS has been challenging; therefore, we sought to determine the clinical and treatment profiles of patients with OMS at the largest pediatric hospital in Latin America. MethodsWe analyzed the data of patients diagnosed with OMS between 2010 and 2020 at Pequeno Principe Hospital (Brazil) to determine the corresponding clinical profile more accurately. ResultsOf the approximately 50,000 visitors to our pediatric neurology department from 2010 to 2020, 10 patients with OMS were observed. Five nontumor cases included three parainfectious and two idiopathic cases. The median time from symptom onset to diagnosis was 34 days. All patients with diagnostic OMS criteria in the idiopathic, nontumor group underwent whole-exome sequencing, with potentially pathogenic mutations identified in two cases. Nine patients were treated with methylprednisolone pulse, followed by oral steroids; eight received one or more intravenous immunoglobulin treatments; and six received azathioprine and cyclophosphamide. Complete symptomatic recovery was observed in only one patient. ConclusionsOMS diagnosis remains challenging. Diagnostic suspicion is necessary to improve the management of these patients and allow early immunosuppressive treatment. Paraneoplastic etiology is the most prevalent. In idiopathic patients who do not respond to immunosuppressive treatment, tests, such as whole-exome sequencing, may reveal a differential diagnosis. Genetic alterations that increase the risk of tumors may be an important clue to the pathophysiology of OMS.

Hyperosmolar hyperglycemic state presenting as transient global aphasia

Hyperosmolar hyperglycemic state (HHS) is an emergency condition characterized by severe dehydration secondary to uncontrolled hyperglycemic state in the absence of ketoacidosis. HHS can present with a variety of neurological symptoms including encephalopathy and seizures. In this report, we present a case of acute-onset transient global aphasia in a 65-year-old male with chronic poor glycemic control. Post-evaluation, we establish the etiology of transient global aphasia as HHS in which patient had complete recovery of symptoms following normalization of blood glucose levels.

The efficacy of laser haemorrhoidoplasty (LHP) in the treatment of symptomatic haemorrhoidal disease: Anobservational cohort study.

Laser haemorrhoidoplasty (LHP) is an emerging nonexcisional surgical procedure in which the arteriovenous flow of the haemorrhoidal plexus is interrupted through laser coagulation. The aim of this cohort study was to assess efficacy of LHP in treating symptomatic haemorrhoidal disease through patient satisfaction, remission of symptoms (blood loss, pain, itching, soiling, mucosal prolapse) and recurrence of haemorrhoids. Patients who underwent treatment for symptomatic haemorrhoids (degrees 1-4) through an LHP procedure between 2015 and 2021 were included in the study. A 1470 nm-diode laser was used. A total of 200 patients (71% male, average age 51 years) were analysed. Primary outcomes were patient satisfaction and/or complete recovery of symptoms. Secondary outcomes were operating time, complications and recurrence rates. Patient satisfaction, postoperative blood loss, pain and complications were evaluated 6-7 weeks postoperatively. Room turnover time and operating time were documented. Recurrence of haemorrhoids following LHP treatment within 1 year was evaluated. Patient satisfaction regarding LHP treatment was reached in 155 (84,7%) patients. Postoperative blood loss was reported by 44 (24,0%) patients during time of evaluation. Twenty-four (13,1%) patients reported postoperative pain after 6-7 weeks. Postoperative complications occurred in seven patients (3 anal fissures, 2 perianal abscess, 1 perianal fistula, 1 postoperative anaemia). Room turnover time (patient in to patient out) was 21 min with an average operating time of 7min. Recurrence of haemorrhoids within 1 year occurred in 50 (27,3%) patients. Laser haemorrhoidoplasty appears to be a promising and effective nonexcisional surgical procedure in the treatment of symptomatic haemorrhoidal disease with high patient satisfaction, acceptable postoperative symptoms, minimal complications and short operating times.

Rare Causes of Recurrent Acute Liver Failure In Children: Infantile Liver Failure Syndromes.

Recurrent acute liver failure (RALF) is a rare clinical entity characterized by recurrent episodes of acute liver failure and complete recovery of symptoms and laboratory findings within the episodes. Causes include autoimmune disease, which may flare and subside; intermittent exposure to toxins, as with ingestions; and metabolic disorders affecting the mitochondrial respiratory chain, the long-chain fatty acid oxidation pathway or the carnitine cycle, dihydrolipoamide dehydrogenase (E3) deficiency, Wolcott-Rallison syndrome and citrullinemia (Haack TB et al., Am J Hum Genet 2015; 97: 163–9. Bindi V et al., Arch Argent Pediatr 2017; 115: 39–42). However, approximately 50% of the patients cannot be diagnosed despite detailed laboratory investigations. It is likely that monogenic disorders could explain at least some of these undiagnosed cases.

Minimally Invasive Carpal Tunnel Release Using a Hook Knife through a Small Transverse Carpal Incision: Technique and Outcome.

Compared to the classic open technique, limited exposure techniques have the advantages of less scar pain, more grip and pinch strength, and earlier return to daily life. We evaluated the effectiveness and safety of our novel method of minimally invasive carpal tunnel release using a hook knife through a small transverse carpal incision. This study included 111 carpal tunnel decompressions in 78 patients who underwent carpal tunnel release from January 2017 to December 2018. We performed carpal tunnel release using a hook knife through a small transverse incision just proximal to the wrist crease under local infiltration of lidocaine with tourniquet inflation in the upper arm. All patients were tolerable during the procedure and discharged following the procedure on the same day. At an average of 29.4 months of follow-up (range, 12-51 months), all but one patient (99%) revealed complete or near complete symptomatic recovery. The average of the symptom severity score on the Boston questionnaire was 1.31 ± 0.30 and the average of the functional status score was 1.19 ± 0.26. The final mean Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH) score was 8.66 (range, 2-39). There was no superficial palmar arch injury or nerve injury of the palmar cutaneous branch, recurrent motor branch, or median nerve itself as a complication of the procedure. No patient showed any wound infection or wound dehiscence. Our carpal tunnel release using a hook knife through a small transverse carpal incision performed by an experienced surgeon is a safe and reliable method that is expected to have the benefits of simplicity and minimal invasiveness.

Spontaneous clinical and radiological resolution of a large extruded disc in the lumbar spine

Low back ache arising due to a herniated lumbar disk with radicular pain to the lower limbs is a commonly occurring problem evaluated by spine surgeons. Conservative treatment has usually been proposed for an acute disk prolapse in cases without significant motor or sensory deficit. Spontaneous radiological regression of an extruded herniated disk with complete symptomatic recovery has occasionally been reported. A case of conservatively treated large extruded lumbar disk is described who showed complete radiological resolution, along with regression of the clinical symptoms.

Spontaneous Bleeding From Orbital Cavernous Hemangioma: A Case Report

Cavernous hemangioma is the most frequent primary orbital tumor seen in adults. It is a benign lesion but may compromise optic nerve function. Acute presentation with hemorrhage into the tumor is a rare occurrence with only ten cases reported in literature. We report an unusual case of a sudden painful proptosis with unilateral blindness due to acute bleeding of cavernous hemangioma, MRI revealed an intraconal soft tissue mass of the left orbit. Results: Patient underwent a transcranial approach and tumor was removed. The histopathological examination revealed a cavernous hemangioma. The patient had complete symptomatic recovery following surgery. Conclusion: Orbital hemangiomas presenting with hemorrhage is rare and should be evocated on first.

Clinical and radiological response of aggressive dural arteriovenous fistula after combined glue embolization and hypofractionated helical TomoTherapy

AbstractPurpose:We reported the clinical and radiological outcome of an aggressive dural arteriovenous fistula (DAVF) after combined glue embolization and hypofractionated helical TomoTherapy (Hypo-HT).Materials and methods:Eleven patients whose radiological examinations are consistent with aggressive DAVF were treated with combined glue embolization and Hypo-HT 30–36 Gy in 5–6 fractions. The dosimetric analysis, clinical response and radiological imaging obliteration rate by magnetic resonance angiography or computed tomography angiography were investigated.Results:There were eight males and three females with a male and female ratio of 2·67. The mean age was 51·2 years old (range 37–69). Anatomical imaging sites of disease included transverse-sigmoid sinuses (n = 7), superior sagittal sinus (n = 3) and tentorium cerebelli (n = 1). The mean pitch and MF of treatment plans were 0·273 ± 0·032 and 1·70 ± 0·31, respectively. The average size of PTV were 15·39 ± 7·74 cc whereas the Reff,PTV was 1·50 ± 0·25 cm. The average Dmax and Dmin were 37·52 ± 3·34 and 31·77 ± 2·64 Gy, respectively. HI, CI and CI50 were 0·16 ± 0·06, 1·80 ± 0·56 and 7·85 ± 4·16, respectively. The Reff,Rx and Reff,50%Rx were 1·80 ± 0·24 and 2·90 ± 0·45 cm, respectively. The Reff between 50%Rx and 100%Rx was 1·10 ± 0·28 cm on average. With a mean follow up of 28·5 months (range 9–48), the complete recovery of symptoms was found in 72·7 % (eight patients) within 2–12 months after completion Hypo-HT. Partial recovery was reported in 18·2% (two patients). No clinical response was found in 9·1% (one patient). The total radiographic obliteration rate was 27·3% (three patients), subtotal obliteration was 27·3% (three patients) and partial obliteration was 45·4% (five patients).Conclusions:Satisfactory clinical response of aggressive DAVF was found in all treated patients by combining glue embolization and Hypo-HT. All dosimetric parameters were acceptable. We still need an extended follow up time to assess further radiographic obliteration rate and late side effects of the treatment.

POS-713 TACROLIMUS INDUCED HEPATIC VENO OCCLUSIVE DISEASE IN RENAL TRANSPLANT PATIENT

Tacrolimus is widely used immunosuppressive agent used in solid organ transplant recipients to prevent rejection. It is a calcineurin inhibitor which results in reduced transcription of IL-2 levels thereby mediating the process of preventing rejection. It is extensively metabolized by cytochrome P-450 CYP3A enzymes in the liver and its drug level monitoring is very crucial in managing such patients as it is associated with wide array of adverse effects and multiple drug-drug interactions. Hepatic veno occlusive disease a non thrombotic veno occlusion of hepatic vein is a rare and reversible adverse effect of tacrolimus is being discussed. A 39 year old male with native kidney disease of IgA nephropathy presented 10 months post transplant with fever and cough. He was triple immunosuppression with tac level of 5.8 ng/ml on Tacrolimus 2mg twice daily. He was diagnosed with Aspergillus fumigatus pneumonia for which he was started on Voriconazole. On third day of antifungal he developed acute onset abdominal distension with ascites. Ascitic fluid analysis was suggestive of high SAAG, high protein fluid and contrast enhanced CT abdomen showed significant stenosis of hepatic vein at its confluence of IVC. Concomitantly checked Tacrolimus trough level was greater than 40ng/ml. Gradually tacrolimus dose was reduced and Tacrolimus trough levels were maintained between 2-5 ng/ml. With reduction of tacrolimus dose his ascites reduced and repeat CT abdomen showed opening of hepatic veins.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Hepatic veno occlusive disease is more common in patients with stem cell transplant recipients rather than solid organ transplant patients. HVOD in SOT recipients has been mostly related to the use of Azathioprine and has been rarely reported with pancreas and lung transplant patients. Herewith reporting an rare case of Tacrolimus induced hepatic veno occlusive disease in a renal transplant patient associated with raised tacrolimus trough levels > 40ng/ml due to the concomitant usage of Voriconazole (Known to inhibit metabolism of Tacrolimus). This patient had a complete recovery of symptoms following reduction in dosage of Tacrolimus. In summary, tacrolimus (especially in the event of an overdose), alone or in combination with drugs known to cause VOD (like Azathioprine, valaciclovir) or known to inhibit the metabolism of CNIs may give rise to VOD. It is therefore necessary to monitor tacrolimus levels and liver parameters throughout treatment. In the event of clinical or biochemical abnormalities, appropriate monitoring of drug levels, reduction in dosage of tacrolimus may completely reverse this dreadful life threatening complication.

Foreign body aspiration imitating a difficult-to-treat asthma

Tracheobronchial foreign body (FB) aspiration is an infrequent but possibly fatal event in adults. Symptoms typically consist of a choking incident followed by cough and dyspnea; however, these findings are conflicting, and symptoms may mimic other chronic pulmonary diseases such as asthma or chronic obstructive pulmonary disease. Chest radiography and computed tomography can offer information with regard to the site and features of the FB and support the diagnosis. Bronchoscopy remains the gold standard for diagnosis and management of FB aspiration. A 38-year-old woman with persistent cough of 4 months’ duration, received several lines of treatment for bronchial asthma. She presented with refractory cough and chest tightness, and high-resolution computed tomography chest showed a small calcified lesion in the bronchus intermedius. Fiberoptic bronchoscopy revealed a chicken bone in the bronchus intermedius which was removed, followed by a complete recovery of symptoms and discontinuation of all asthma treatment.

Ogilvijev sindrom nakon operacije kičmenog stuba

Objective: Ogilvie syndrome is a rare disease characterized by acute abdominal pain and distention in the absence of mechanical obstruction. It is a rare condition that usually affects hospitalized patients in association with severe illness or after surgery. A few cases have been reported after spinal surgery. Material and Methods: Retrospective reports of Ogilvie syndrome in three patients that underwent spinal surgery (two posterior lumbar instrumented fusion and one anterior cervical fusion). Surgical treatment was required in two patients and conservative treatment in one out the three patients. Results: Two patients had a complete recovery of symptoms and signs of the disease, and one died. Conclusion: Ogilvie syndrome is rare, but it should be considered a differential diagnosis in patients who have undergone surgery and present with significant abdominal pain and distention. Level of evidence II; Retrospective study.

Surgical Treatment of Vertebral Artery Stenosis: An Overlooked Surgery with Low Morbidity

Vertebral artery (VA) stenosis as a cause of ischemic events and its surgical treatment is an overlooked subject. After reporting our initial results, the results of VA stenosis operations and the follow-up studies are analyzed. This retrospective, single-center study includes 43 symptomatic proximal VA stenosis patients between September 2012 and March 2019. The demographics and clinical data were obtained from the hospital records. Doppler ultrasonography and computed tomography angiography were used to establish the diagnosis and for follow-up. The surgical procedures were as follows: VA transposition in 30 (69.8%), VA bypass 8 (18.6%), saphenous vein interposition in VA in 4 (9.3%), and decompression of kinking in 1 (2.3%) patient. Eleven patients (25.5%) had concomitant carotid surgery. The Kaplan-Meier method was used to calculate the survival and patency rates. Most common symptoms were vertigo and loss of balance in 38 (88.4%) and 14 (32.6%) patients, respectively. Twenty-five patients were males (58.1%), and the average age was 64.6±9.8 (50-90) years. The 30-day death, 30-day stroke, and 30-day death/stroke rates were 2.3%, 4.7%, and 7%, respectively. Ten patients (23.3%) had morbidities which were related to the intervention. Horner syndrome was found in 5 (11.6%) patients, and facial nerve injury was found in one (2.3%) patient. Three (7.1%) patients died during the follow-up period, and overall survival of the patients at 3years was 91.4%±5.8%. Two (4.7%) patients had cerebrovascular events (CVEs) occurred during the follow-up. One- and three-year CVE-free survivals were 97.1%±2.9% and 90.1%±7.2%, respectively. Two patients (5.4%) had restenosis. One- and three-year patency of VA after procedure was 89.1%±7.4%. Thirty-seven (86%) patients had complete recovery of symptoms after surgery; 5 patients (11.6%) kept their preoperative symptoms in different levels. Vertebral artery surgery can be performed with acceptable mortality and morbidity rates. Restenosis-free, CVE-free, and overall survival rates are satisfactory.

MISC 13. Analysis of Prognosis and Predictors for Spontaneous Isolated Superior Mesenteric Artery Dissection

The objective of this study was to analyze the prognosis and predictors for patients with spontaneous isolated superior mesenteric artery (SMA) dissection (SISMAD). A total of 147 consecutive SISMAD patients from 2013 to 2017 were evaluated retrospectively. Forty-eight clinical, radiologic, and laboratory prognostic factors were counted and evaluated using univariate and multivariate logistic regression analyses. The follow-up time was 6 to 66 months (average, 31 months). Complete remodeling was observed in 32 patients (22%). The independent predictors were heart rate (hazard ratio [HR], 0.358; P = .031), alcoholism (HR, 0.272; P = .023), SMA normal diameter (HR, 2.674; P = .047), and SMA thrombosis (HR, 0.186; P = .009). Thirty-eight patients (26%) still had clinical symptoms, and body mass index (HR, 2.735; P = .036), initial symptoms (HR, 2.534; P = .045), and aorta-SMA angle (HR, 0.418; P = .049) were demonstrated to be significant predictors. The radiologic and clinical prognoses were inconsistent in 89 patients and associated with initial symptoms (HR, 0.288; P = .004) and SMA normal diameter (HR, 2.894; P = .016). The overall prognosis of SISMAD was fine. However, the rates of complete remodeling and complete recovery of symptoms were relatively low, and the radiologic and clinical prognoses were inconsistent.

Remote cerebellar hemorrhage as complication of spinal surgery

Introduction: The occurrence of remote cerebellar hemorrhage (RCH) during spinal surgery is a rare event and can go undetected in the majority of cases. A mortality rate of almost 15% has been reported. Case report: We present two cases of patients presenting with cerebellar hemorrhage after lumbar spine surgery complicated with dural rupture. A review of its physiopathological mechanisms is made. In both cases the diagnosis was made during the investigation of neurological deficits in early postoperative period. In the first case, there was dural rupture due to disruption of the pre-existing vertebral osteosynthesis material. In the second case, the existence of a dural fistula was noticed after the procedure, responsible for the cerebrospinal fluid (CSF) leakage. Neuroimaging studies of two patients showed the classic “zebra-sign”. Expectant treatment was applied in both cases, with complete recovery of symptoms. Discussion: The pathophysiological mechanism of RCH is still unknown, but it’s supposed that it is due to intracranial hypotension caused by CSF leakage, which causes a caudal displacement of the cerebellum, that might lead to stretching and disruption of the vermian veins. Expectanttreatment can be applied in cases of minor bleeding, with surgical evacuation in cases of major bleeds. Prognosis is usually favorable, with minor transient neurological deficits.

A child with distal (type 1) renal tubular acidosis presenting with progressive gross motor developmental regression and acute paralysis

BackgroundDistal (Type 1) renal tubular acidosis (dRTA) is characterized by inability to secrete hydrogen irons from the distal tubule. The aetiology of dRTA is diverse and can be either inherited or acquired. Common clinical presentations of dRTA in the paediatric age group include polyuria, nocturia, failure to thrive, constipation, abnormal breathing and nephrolithiasis. Though persistent hypokalemia is frequently seen in dRTA, hypokalemic muscular paralysis is uncommon and rarely described in children.Case presentationThree and a half years old girl was referred for evaluation of progressive loss of gross motor milestones over 6 months and acute episode of paralysis. Her other developmental domains were age appropriate. Notably, there was no history of polyuria, polydipsia, nocturia and abnormal breathing. Physical examination revealed proximal myopathy (waddling gait and positive Gower’s sign), diminished lower limb reflexes and muscle tone. Her serum potassium was low (2.1 meq/l) and she was subsequently investigated for hypokalemic paralysis. Diagnosis of distal renal tubular acidosis was made, based on hypokalemic hyperchloremic metabolic acidosis with normal anion gap, high urine pH, borderline hypercalciuria, medullary nephrocalcinosis and exclusion of other differential diagnosis. The child showed complete symptomatic recovery upon commencement of standard treatment for distal renal tubular acidosis.ConclusionsThis case report highlights the importance of considering hypokalemia and renal tubular acidosis in the differential diagnosis of acute flaccid paralysis and proximal myopathy. Early diagnosis will prevent costly investigations and enable rapid clinical recovery in the affected child.

Nasolabial Perforator Flap for One-stage Reconstruction of Nasal Defects.

Background:The excellent freedom of movement and range of this flap when based on a the nasolabial perforator flap have not been sufficiently explored. In this study, along with demonstrating the other key advantages of this flap over its traditional counterpart, we will endeavour to fill these lacunae in the available literature.Materials and Methods:From February 2009 to February 2012, twenty patients with nasal defects were repaired with a nasolabial perforator flap in the Department of Plastic and Cosmetic Surgery at Sir Ganga Ram Hospital, New Delhi. Of these, two patients (10%) underwent the procedure bilaterally. Thus, a total of 22 nasolabial perforator flap procedures were carried out. Prospectively, collected clinical records and data of each patient were retrospectively retrieved and reviewed to study the nasal defect and surgery done.Results:All the twenty (100%) patients had good functional and aesthetic outcome. All patients who had nasal stenosis preoperatively had very good improvement in the patency of the nasal passages, breathing and nasal blockage with complete recovery of symptoms. The patients were entirely satisfied with the functional recovery.Conclusions:The reliability and versatility of the nasolabial perforator flap exceed its recognised application in reconstruction of nasal defects and it must form a part of every plastic surgeon's armamentarium.

A Late Presentation of Amiodarone -Induced Hepatotoxicity

A 74-year-old man with heart failure and atrium fibrillation was admitted to hospital in case of persistent dyspepsia and disturbed liver test functions. Ultrasound and detailed laboratory tests didn’t reveal infectious disease of the liver or biliary obstruction. A diagnosis of hepatotoxicity due to amiodarone use was made. Withdrawal of the drug led to complete recovery of symptoms and normalization of laboratory tests.

The role of chronic norovirus infection in the enteropathy associated with common variable immunodeficiency.

A severe enteropathy of unknown etiology can be associated with common variable immunodeficiency (CVID). S tool and archived small intestinal mucosal biopsies from patients with CVID enteropathy were analyzed by PCR for the presence of Norovirus RNA. The PCR products were sequenced to determine the relationship of viral isolates. Stool samples from 10 patients with CVID but no enteropathy served as controls. All eight patients in our CVID cohort with enteropathy showed persistent fecal excretion of Norovirus. Analysis of archived duodenal biopsies revealed a strong association between the presence of Norovirus and villous atrophy over a period of up to 8 years. Analysis of the viral isolates from each patient revealed distinct strains of genogroup II.4. Sequence analysis from consecutive biopsy specimens of one patient demonstrated persistence of the same viral strain over a 6-year period. CVID patients without enteropathy showed no evidence of Norovirus carriage. Viral clearance occurred spontaneously in one patient and followed oral Ribavirin therapy in two further patients, and resulted in complete symptomatic and histological recovery. However, Ribavirin treatment in two further patients was unsuccessful. Norovirus is an important pathogen for patients with CVID and a cause of CVID enteropathy, as viral clearance, symptom resolution, and histological recovery coincide. Ribavirin requires further evaluation as a potential therapy.

Clinical characteristics and outcome of the capsular warning syndrome: a multicenter study.

The capsular warning syndrome is defined as recurrent transient lacunar syndromes that usually precede a capsular infarction. Several aspects regarding the clinical management are controversial. We report the clinical and radiological characteristics of a multicenter series of patients with capsular warning syndrome, as well as their functional outcome during the follow-up. We sought to describe the clinico-radiological spectrum of the capsular warning syndrome and to report the functional outcomes and recurrences of these patients during the follow-up. We conducted a multicenter study that collected clinical and radiological data from patients with capsular warning syndrome during 2003-2013. Capsular warning syndrome was defined as the succession of three or more motor or sensory-motor lacunar syndromes within a period of 72 h, with complete recovery between them. We recorded the functional outcome (favorable when Rankin scale score ≤2) and recurrences during follow-up. Our study included 42 patients whose mean age was 66.4 ± 10 years; 71.4% of them were men. The mean number of episodes before a permanent neurological impairment occurred or before a complete recovery of symptoms was 5.1 ± 2.3. Up to 30 patients (71.2%) had an acute infarct visible on the neuroimaging (computed tomography/magnetic resonance imaging). The internal capsule was the most frequent infarct location (50%), but other locations were noted. Twelve patients (28.6%) received thrombolysis in the acute phase. A favorable outcome was observed in 39 patients (92.9%). After a mean follow-up of 35 ± 29 months, only one patient suffered a recurrent ischemic stroke. Capsular warning syndrome preceded an ischemic infarction in 71.2% of patients. In addition to the internal capsule, other locations were noted. The most effective treatment remains unclear. The functional prognosis is favorable in most patients and recurrences are rare.