CASE REPORT: THE CAPSULAR WARNING SYNDROME
1 Neurology Department , Hospital Pengajar Universiti Putra Malaysia
Capsular warning syndrome (CWS) is defined as a recurrent stereotype transient lacunar syndrome. The mechanism and clinical management of CWS has not been extensively studied. We present a case of a 56-year-old gentleman with comorbid hypertension, dyslipidaemia, diabetes mellitus type 2 and morbid obesity who had a left-sided weakness and numbness associated with dysarthria after waking up from sleep. He was not thrombolysed in view of low NIHSS on admission. Brain's magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) showed acute right basal ganglia infarction and small vessel disease respectively. During admission, he had a few episodes of fluctuating limbs weakness with a complete resolution of the symptoms in between. Initially, it was postulated due to transient ischaemic attack (TIA) but the fluctuation episodes lasted up to four days when the patient eventually experienced persistent limb weakness. Repeated neuroimaging showed a non-evolving right basal ganglia infarct. He received double antiplatelet medication – a combination of Aspirin and Clopidogrel for a duration of 4 weeks followed by single antiplatelet- Aspirin alone for lifelong. His Modified Rankin Score (MRS) score was 3 (moderate disability) at discharge which improved to 2 (slight disability) at 90 days of stroke assessment of the functional outcome. The history and clinical findings of this case were classical of capsular warning syndrome. In this case, we reported that DAPT treatment in CWS showed a slight favorable functional outcome at 90 days of stroke.
We reported a case of CWS with fluctuating neurological symptoms showing consistent and favourable outcomes at 90 days of treatment with DAPT. In the light of this single case report, we would suggest a randomized control study to clarify the role of DAPT as one of the important therapeutic options for CWS patients.