Two cases of rt-PA with dual antiplatelet therapies with capsular warning syndrome

Abstract

Rationale:Capsular warning syndrome (CWS) is a term to describe stereotyped lacunar transient ischemic attacks (TIAs). Patients with CWS are at high risk of developing completed stroke. However, the exact pathophysiology of CWS is still unclear, and there is no conclusive clinical strategy for CWS patients.Patient symptoms:Two cases of middle-aged men with hypertension, hyperlipidemia, and diabetes mellitus presented with fluctuating right-sided weakness, numbness, and dysarthria.Diagnoses:These two patients were diagnosed with CWS.Interventions:Recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis (0.9mg/kg) was administered first and treated with aspirin (100mg) and clopidogrel (75mg) after 24h of rt-PA for 21days following by aspirin (100mg) alone.Outcomes:Both cases got favorable clinical outcomes of somatic symptoms. In addition, diffusion-weighted imaging (DWI or DW-MRI) showed that ischemic injury disappeared in case 1 while maintained within a reasonable range in case 2.Lessons:Early recognition and rt-PA/dual antiplatelet treatment may be an effective strategy for patients with CWS.