Background
- Recurrent, transient, stereotyped episodes of unilateral motor ± sensory symptoms
- Classically without cortical signs (neglect, hemianopia, aphasia etc), with a high risk of developing an ischaemic infarct
- 24 to 72 hours
- Incidence of 1-5% of patients with TIA
- High risk of developing an ischaemic infarct (up to 70%)
- Internal capsule most frequent location of infarcts
- Some infarcts in pons, midbrain or thalamus
Aetiology
Small vessel disease risk factors are common, such as:
- Smoking
- HTN
- Atherosclerotic disease
- DM
Suggested aetiologies:
- Small perforating artery disease
- Intermittent haemodynamic changes secondary to structural arterial changes
Clinical
- >1 TIA episode within a few days, with absence of cortical signs
- Complete recovery between episodes
Management CUH
- Admit under stroke service
- Ix and Mx per usual TIA/stroke protocol ("How to admit a patient with stroke/TIA – a guide of Registrars and SHOs")
- These patients should be managed in the HASU, for close monitoring of recurrence of symptoms
- Recurrence of symptoms in hospital should trigger a FAST call
- Considered tPa (evidence is limited)
- Maintain perfusion by avoiding hypotension
- Discuss suspicion of CWS or any concerns with Stroke Consultant on-call
Links/references
- He, L., Xu, R., Wang, J. et al. Capsular warning syndrome: clinical analysis and treatment. BMC Neurol 19, 285 (2019). https://doi.org/10.1186/s12883-019-1522-0
- Martínez HR, Figueroa-Sanchez JA, Arreola-Aldape CA, Moran Guerrero JA, Trujillo-Bracho AL, Cantú López A. Capsular warning syndrome and its clinical awareness and therapeutic approach: two case reports and a systematic review of the literature. Front Neurol. 2023 May 16;14:1177660. doi: 10.3389/fneur.2023.1177660. PMID: 37260605; PMCID: PMC10227623