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Kawatake A, Kawano H, Honda Y, Unno Y, Hirano T. [Cilostazol was effective for capsular warning syndrome during anticoagulant therapy: a case report]. Rinsho Shinkeigaku 2024; 64:181-184. [PMID: 38369326 DOI: 10.5692/clinicalneurol.cn-001927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
An 88-year-old woman with atrial fibrillation was admitted to our hospital due to the right hemiplegia and aphasia. MRA shows the left middle cerebral artery M2 occlusion. After intravenous rt-PA, her symptoms improved. She was diagnosed with cardioembolic stroke, and was treated with direct oral anticoagulation therapy. However, she had repeated stereotypical transient right hemiparesis a week after index stroke. Her symptoms were considered capsular warning syndrome (CWS). After cilostazol was administered, no further transient neurological deteriorations occurred. CWS can coexist with acute cardioembolic stroke, and cilostazol was effective.
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Affiliation(s)
- Ayane Kawatake
- Department of Stroke and Cerebrovascular Medicine, Kyorin University
| | - Hiroyuki Kawano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University
| | - Yuko Honda
- Department of Stroke and Cerebrovascular Medicine, Kyorin University
| | - Yoshiko Unno
- Department of Stroke and Cerebrovascular Medicine, Kyorin University
| | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University
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Nikolenko VN, Rizaeva NA, Oganesyan MV, Vekhova KA, Alyautdinova NAF, Balan SI, Karashaeva TA, Bolotskaya AA. Brain commissures and related pathologies. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2022. [DOI: 10.14412/2074-2711-2022-6-73-79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- V. N. Nikolenko
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University); Lomonosov Moscow State University
| | - N. A. Rizaeva
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University); Lomonosov Moscow State University
| | - M. V. Oganesyan
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University); Lomonosov Moscow State University
| | - K. A. Vekhova
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University)
| | | | | | - T. A. Karashaeva
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University)
| | - A. A. Bolotskaya
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University)
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He L, Xu R, Wang J, Zhang L, Zhang L, Zhou F, Dong W. Capsular warning syndrome: clinical analysis and treatment. BMC Neurol 2019; 19:285. [PMID: 31722675 PMCID: PMC6854731 DOI: 10.1186/s12883-019-1522-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/05/2019] [Indexed: 11/30/2022] Open
Abstract
Background Capsular warning syndrome (CWS) is a rare clinical syndrome, which is defined as a recurrent transient lacunar syndrome. The mechanism and clinical management of CWS remain unclear. The aim of the study was to discuss the clinical characteristics of CWS and evaluate the different outcome between rt-PA and no rt-PA therapy. Methods The present multicenter retrospective study involved three medical centers, and the clinical data were collected from patients with CWS between January 2013 and December 2018. The clinical characteristics of CWS were analyzed. Patients were divided into two groups: rt-PA and no rt-PA groups. The therapeutic effects and prognosis of these two groups were analyzed. A good prognosis was defined as 3-month modified Rankin Scale (mRS) ≤ 2. Results Our study included 72 patients, 27 patients were assigned to rt-PA group, 45 in no rt-PA group. Hypertension and dyslipidemia were the most common risk factors. The mean number of episodes before irreversible neurological impairment or the symptoms completely disappeared was five times (range: 3–11 times). A total of 58 (80.55%) patients had acute infarction lesions on the diffusion weighted imaging (DWI). The most common infarct location was the internal capsule (41,70.69%), followed by the thalamus and pons. The difference in therapeutic effects between the rt-PA, single and double antiplatelet groups was not statistically significant (P > 0.05). A good prognosis was observed in 61 (84.72%) patients after 3 months, in which 23 (23/27, 85.19%) patients were from the rt-PA group and 38 (38/45,84.44%) patients were from the no rt-PA group (P > 0.05). After 3 months of follow-up, two patients had recurrent ischemic stroke. Conclusion The most effective treatment of CWS remains unclear. Intravenous thrombolysis is safe for CWS patients. Regardless of the high frequency of infarction in CWS patients, more than 80% patients had a favorable functional prognosis.
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Affiliation(s)
- Lanying He
- Department of Neurology, The Second People's Hospital of Chengdu, Chengdu, 610021, People's Republic of China
| | - Ronghua Xu
- Department of Neurosurgery, The Second People's Hospital of Chengdu, Chengdu, 610021, People's Republic of China.
| | - Jian Wang
- Department of Neurology, The Second People's Hospital of Chengdu, Chengdu, 610021, People's Republic of China
| | - Lili Zhang
- Department of Neurology, The Second People's Hospital of Chengdu, Chengdu, 610021, People's Republic of China
| | - Lijuan Zhang
- Department of Neurology, The Second Affiliated Hospital of Chengdu College, Nuclear Industry 416 Hospital, Chengdu, 610021, People's Republic of China
| | - Fangfang Zhou
- Department of Neurology, The Second People's Hospital of Chengdu, Chengdu, 610021, People's Republic of China
| | - Weiwei Dong
- Department of Neurology, First Affiliated Hospital, Chongqing Medical University, Chongqing, China, 400030, People's Republic of China
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Kamo H, Miyamoto N, Otani H, Kurita N, Nakajima S, Ueno Y, Yamashiro K, Tanaka R, Hattori N. The Importance of Combined Antithrombotic Treatment for Capsular Warning Syndrome. J Stroke Cerebrovasc Dis 2018; 27:3095-3099. [PMID: 30077604 DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/22/2018] [Accepted: 06/30/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Capsular warning syndrome (CWS) is characterized by recurrent conventional episodes of motor and/or sensory deficits without cortical symptoms. The purpose of this case series study was to evaluate the safety and appropriate treatment for CWS to prevent the development of complete stroke. METHODS We reviewed our hospital records and previous reports to find patients with neurologically fluctuating profiles, and excluded those with unknown details of initial treatment/final treatment of antiplatelet therapy or radiological findings. RESULTS We retrieved two cases of CWS from our hospital, which presented motor and/or sensory symptoms followed by complete resolution without complete ischemia. The recurring episodes in both were unable to be stabilized by single antiplatelet therapy but were successfully managed using two or more antiplatelet drugs. In 11 previously reported cases of CWS, the recurring episode was frequency stabilized with plural antiplatelet therapy. CONCLUSION Multiplicate antiplatelet therapy is important for treatment of CWS, and caution is needed regarding hemorrhagic complications.
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Affiliation(s)
- Hikaru Kamo
- Department of Neurology, Juntendo University Hospital, Bunkyo, Tokyo, Japan
| | - Nobukazu Miyamoto
- Department of Neurology, Juntendo University Hospital, Bunkyo, Tokyo, Japan.
| | - Hana Otani
- Department of Neurology, Juntendo University Hospital, Bunkyo, Tokyo, Japan
| | - Naohide Kurita
- Department of Neurology, Juntendo University Hospital, Bunkyo, Tokyo, Japan
| | - Sho Nakajima
- Department of Neurology, Juntendo University Hospital, Bunkyo, Tokyo, Japan
| | - Yuji Ueno
- Department of Neurology, Juntendo University Hospital, Bunkyo, Tokyo, Japan
| | - Kazuo Yamashiro
- Department of Neurology, Juntendo University Hospital, Bunkyo, Tokyo, Japan
| | - Ryota Tanaka
- Department of Neurology, Juntendo University Hospital, Bunkyo, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Hospital, Bunkyo, Tokyo, Japan
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Abstract
INTRODUCTION Crescendo transient ischemic attacks or "Stroke Warning Syndromes" consist of stereotyped frequent short-lasting episodes of focal neurological deficits. This is explained by intermittent hypoperfusion of the vascular territory of terminal arteries with insufficient collateral flow, presenting a high risk for subsequent infarction. Pontine warning syndrome (PWS) is a subtype of this atypical presentation of stroke/transient ischemic attack and is considered a challenge for diagnosis. CASE REPORT We describe 2 cases of patients with PWS who were admitted to our institution. They presented acute neurological deficits that fluctuated during the course of their hospitalization; interestingly, this neurological worsening and improvement was associated with blood pressure fluctuations. In both cases, brain magnetic resonance imaging revealed an ischemic lesion in the paramedian pons due to basilar artery branch disease. No outstanding infectious or metabolic factors contributed to neurological worsening/fluctuations. These patients received standard medical care without IV-thrombolysis because of the presence of contraindications for IV tissue plasminogen activator. Permissive hypertension was promoted to achieve adequate perfusion during hospitalization. At discharge and follow-up, the patients showed partial resolution from their stroke symptoms. CONCLUSIONS PWS is a diagnostic and management challenge for the clinician. Because of its low incidence, this syndrome has been underestimated and understudied. There is, currently, no standard treatment for this condition; however, it is paramount, during treatment, that hypotension/hypoperfusion be avoided, with the goal being asymptomatic normotension to permissive hypertension. The probable mechanism of disease is hypoperfusion due to basilar artery branch disease and perhaps cerebral vascular dysregulation in the affected area.
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Sarva H, Deik A, Severt WL. Pathophysiology and treatment of alien hand syndrome. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4:241. [PMID: 25506043 PMCID: PMC4261226 DOI: 10.7916/d8vx0f48] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 10/21/2014] [Indexed: 12/01/2022]
Abstract
Background Alien hand syndrome (AHS) is a disorder of involuntary, yet purposeful,
hand movements that may be accompanied by agnosia, aphasia, weakness, or sensory
loss. We herein review the most reported cases, current understanding of the
pathophysiology, and treatments. Methods We performed a PubMed search in July of 2014 using the phrases “alien hand
syndrome,” “alien hand syndrome pathophysiology,” “alien
hand syndrome treatment,” and “anarchic hand syndrome.” The
search yielded 141 papers (reviews, case reports, case series, and clinical
studies), of which we reviewed 109. Non-English reports without
English abstracts were excluded. Results Accumulating evidence indicates that there are three AHS variants: frontal,
callosal, and posterior. Patients may demonstrate symptoms of multiple types;
there is a lack of correlation between phenomenology and neuroimaging findings.
Most pathologic and functional imaging studies suggest network disruption causing
loss of inhibition as the likely cause. Successful interventions include botulinum
toxin injections, clonazepam, visuospatial coaching techniques, distracting the
affected hand, and cognitive behavioral therapy. Discussion The available literature suggests that overlap between AHS subtypes is common. The
evidence for effective treatments remains anecdotal, and, given the rarity of AHS,
the possibility of performing randomized, placebo-controlled trials seems
unlikely. As with many other interventions for movement disorders, identifying the
specific functional impairments caused by AHS may provide the best guidance
towards individualized supportive care.
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Affiliation(s)
- Harini Sarva
- Department of Neurology, Maimonides Medical Center, New York, NY, USA
| | - Andres Deik
- Parkinson Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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Abstract
Written language production is often the least examined neuropsychological function, yet it provides a sensitive and subtle sign to a variety of different behavioral disorders. The dissociation between written and spoken language and reading and writing first came to clinical prominence in the nineteenth century, with respect to ideas about localization of function. Twentieth century aphasiology research focused primarily on patients with unifocal lesions from cerebrovascular accidents, which have provided insight into the various levels of processing involved in the cognitively complex task of producing written language. Recent investigations have provided a broader perspective on writing impairments in a variety of disorders, including progressive and diffuse brain disorders, and functional brain imaging techniques have been used to study the underlying processes in healthy individuals.
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Affiliation(s)
- Marjorie Lorch
- Applied Linguistics and Communication, Birkbeck, University of London, 30 Russell Square, London, WC1B 5DT, UK.
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Said S, Cooper CJ, Chowdhury F, Nunez A, Quansah R, Davis HE. A case with unusual stroke and fulminant outcome in a Hispanic male. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:424-9. [PMID: 24167642 PMCID: PMC3808186 DOI: 10.12659/ajcr.889590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 07/25/2013] [Indexed: 11/11/2022]
Abstract
Patient: Male, 42 Final Diagnosis: Moyamoya disease (MMD) Symptoms: Aphasia • concentration difficulty • dysarthria • personality change Medication: — Clinical Procedure: — Specialty: Radiology
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Affiliation(s)
- Sarmad Said
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
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Tassi R, Cerase A, Acampa M, D’Andrea P, Guideri F, Lo Giudice G, Marotta G, Bracco S, Martini G. Stroke warning syndrome: 18 new cases. J Neurol Sci 2013; 331:168-71. [DOI: 10.1016/j.jns.2013.05.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/17/2013] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
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