Capsular warning syndrome: successful treatment with loading dose of dual antiplatelets

Abstract

Introduction: Capsular Warning Syndrome (CWS) is a rare subtype of transient ischaemic attacks (TIA) that presents with recurrent lacunar syndrome without signs of cortical involvement. Despite its potential to cause permanent disability, there is no consensus on its optimal treatment. Various strategies such as thrombolysis, dual antiplatelet therapy (DAT) and antiplatelet with anticoagulation therapy have been suggested. However, no significant superiority has been established.

Method: We present a case of an adult in his forties with no cardiovascular risk factors. Patient presented with five episodes of recurrent left-sided weakness with facial deviation within a span of three hours. Due to complete neurological recovery between episodes, thrombolysis was not attempted. He was given a loading dose (300 mg) of both aspirin and clopidogrel after the fifth episode and dual antiplatelet for 21 days. He made a full recovery, with no neurological deficit and no further episodes.

Results or details of the case: A 300 mg loading dose of DAT has been used successfully in some cases, preventing symptom progression and achieving functional improvements. However, some cases have reported symptomatic progression and infarctions. It has certainly shown promising results in stuttering lacunar syndrome. Our case demonstrates favourable outcomes in a patient with no previous risk factors presenting with CWS.

Conclusion: Despite lack of consensus on the treatment of CWS, we have demonstrated full resolution of symptoms using a loading dose of dual antiplatelets. This case report underscores the necessity for further research to standardise treatment protocols in order to achieve better patient outcomes internationally.