Donnan G A, O'Malley H M, Quang L, Hurley S, Bladin P F
Department of Neurology, Austin Hospital, Melbourne, Australia.
Neurology. 1993 May;43(5):957-62. doi: 10.1212/wnl.43.5.957.
Transient ischemic attacks (TIAs) are not homogeneous and may consist of subsets with mechanisms as varied as their stroke counterparts. We describe a form of TIA in 50 patients where crescendo episodes of ischemia were restricted to the region of the internal capsule, usually causing symptoms affecting face, arm, and leg. These patients composed 4.5% of a consecutive series of patients admitted with TIAs over a 15-year period and 33% of all TIAs classified as subcortical. We believe that the ischemia was most often due to hemodynamic phenomena in diseases, single, small penetrating vessels. When cerebral infarction developed, it was usually lacunar and involved a single penetrating vessel, although occasionally striatocapsular or anterior choroidal artery territory infarction occurred. There was no evidence of artery-to-artery or heart-to-artery embolism. Resistance to various forms of therapy, including hemodiluting, anticoagulant, and thrombolytic agents, was common. Because of dramatic and easily recognizable clinical presentation, apparent specific pathophysiologic mechanism, and the development of early capsular stroke in a high proportion of cases (42%), we have termed this the "capsular warning syndrome."
短暂性脑缺血发作（TIA）并非同质，可能由机制与中风类似的不同亚组组成。我们描述了50例TIA患者的一种类型，其缺血的渐强发作局限于内囊区域，通常导致影响面部、手臂和腿部的症状。这些患者占15年间因TIA连续收治患者系列的4.5%，占所有归类为皮质下TIA的33%。我们认为，缺血最常见的原因是单一的小穿支血管疾病中的血流动力学现象。当发生脑梗死时，通常为腔隙性，累及单一穿支血管，尽管偶尔会出现纹状体内囊或脉络膜前动脉区域梗死。没有动脉到动脉或心脏到动脉栓塞的证据。对包括血液稀释、抗凝和溶栓药物在内的各种治疗形式有抵抗很常见。由于临床表现显著且易于识别、明显的特定病理生理机制以及高比例病例（42%）早期出现内囊中风，我们将此称为“内囊预警综合征”。
