Department of Neurology, Peking Union Medical College Hospital and Chinese Academy of Medical Science, Shuai Fu Yuan 1#, Dong Cheng District, Beijing 100730, China.
BMC Neurol. 2014 Jan 20;14:16. doi: 10.1186/1471-2377-14-16.
Capsular warning syndrome (CWS) is rare (1.5% of TIA presentations) but has a poor prognosis (7-day stroke risk of 60%). Up to date, the exact pathogenic mechanism of CWS has not been fully understood. We report the clinical presentations and high-resolution MRI (HR MRI) findings of two cases with capsular warning symptoms.
Case 1 was a 63-year-old man with a history of hypertension with recurrent episodes of left hemiparesis and dysarthria lasting 10 ~ 30 minutes. Case 2 was a 54-year-old woman with repetitive episodes of transient left hemiparesis and dysarthria lasting about 10 minutes. Capsular infarctions on DWI were demonstrated in the territory of a lenticulostriate artery in both 2 patients. HR MRI disclosed atherosclerotic plaques on the ventral wall of the MCA where enticulostriate arteries were arisen from, although traditional digital subtraction angiography showed normal. Aggressive medical therapy with dual antithrombotic agents and statin was effective in these two cases.
Our HR MRI data offer an insight into the pathophysiology of CWS which might be caused by atherosclerotic plaque in non-stenotic MCA wall. HR MRI might be a useful modality for characterizing atherosclerotic plaques in the MCA and detecting the pathophysiology of the CWS.
囊袋警告综合征（CWS）较为罕见（占 TIA 表现的 1.5%），但其预后较差（7 天内卒中风险为 60%）。迄今为止，CWS 的确切发病机制尚未完全阐明。我们报告了两例具有囊袋警告症状的病例的临床表现和高分辨率 MRI（HR MRI）结果。
病例 1 为 63 岁男性，有高血压病史，反复出现左侧偏瘫和构音障碍，持续 10~30 分钟。病例 2 为 54 岁女性，反复出现短暂性左侧偏瘫和构音障碍，持续约 10 分钟。两例患者 DWI 均显示壳核梗死，位于纹状体动脉供血区。尽管传统的数字减影血管造影显示正常，但 HR MRI 显示 MCA 腹侧壁存在粥样硬化斑块，纹状体动脉由此发出。这两例患者均采用双联抗血栓药物和他汀类药物进行强化治疗，效果良好。
我们的 HR MRI 数据提供了对 CWS 病理生理学的深入了解，其可能是由非狭窄性 MCA 壁中的粥样硬化斑块引起的。HR MRI 可能是一种用于表征 MCA 中粥样硬化斑块和检测 CWS 病理生理学的有用方法。
