title: Clinical characteristics and outcome of the capsular warning syndrome: a multicenter study.
abstract: BACKGROUND
  The capsular warning syndrome is defined as recurrent transient lacunar syndromes that usually precede a capsular infarction. Several aspects regarding the clinical management are controversial. We report the clinical and radiological characteristics of a multicenter series of patients with capsular warning syndrome, as well as their functional outcome during the follow-up.
  
  
  OBJECTIVE
  We sought to describe the clinico-radiological spectrum of the capsular warning syndrome and to report the functional outcomes and recurrences of these patients during the follow-up.
  
  
  METHODS
  We conducted a multicenter study that collected clinical and radiological data from patients with capsular warning syndrome during 2003-2013. Capsular warning syndrome was defined as the succession of three or more motor or sensory-motor lacunar syndromes within a period of 72 h, with complete recovery between them. We recorded the functional outcome (favorable when Rankin scale score ≤2) and recurrences during follow-up.
  
  
  RESULTS
  Our study included 42 patients whose mean age was 66.4 ± 10 years; 71.4% of them were men. The mean number of episodes before a permanent neurological impairment occurred or before a complete recovery of symptoms was 5.1 ± 2.3. Up to 30 patients (71.2%) had an acute infarct visible on the neuroimaging (computed tomography/magnetic resonance imaging). The internal capsule was the most frequent infarct location (50%), but other locations were noted. Twelve patients (28.6%) received thrombolysis in the acute phase. A favorable outcome was observed in 39 patients (92.9%). After a mean follow-up of 35 ± 29 months, only one patient suffered a recurrent ischemic stroke.
  
  
  CONCLUSIONS
  Capsular warning syndrome preceded an ischemic infarction in 71.2% of patients. In addition to the internal capsule, other locations were noted. The most effective treatment remains unclear. The functional prognosis is favorable in most patients and recurrences are rare.
authors.affiliation: Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Pol
authors.initials: P
authors.lastname: Camps-Renom
authors.affiliation: Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Delgado-Mederos
authors.affiliation: Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Martínez-Domeño
authors.affiliation: Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Luís
authors.initials: L
authors.lastname: Prats-Sánchez
authors.affiliation: Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Cortés-Vicente
authors.affiliation: Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Simón-Talero
authors.affiliation: Department of Neurology, Hospital Sagrat Cor, Barcelona, Spain.
authors.forename: Adrià
authors.initials: A
authors.lastname: Arboix
authors.affiliation: Department of Neurology, Hospital del Mar, Barcelona, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Ois
authors.affiliation: Department of Neurology, Hospital Arnau de Vilanova, Lleida, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Purroy
authors.affiliation: Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Martí-Fàbregas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D002545:Brain Ischemia / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020772:Internal Capsule / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D059409:Stroke, Lacunar / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: capsular warning syndrome; ischemic stroke; stroke warning syndrome; thrombolysis; transient ischemic attack; vascular warning syndrome