• Xiaofan Xue, Heng Zhou, and Lichun Zhou.
• Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
• Medicine (Baltimore). 2021 Mar 5; 100 (9): e24698e24698.

RationaleCapsular 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 SymptomsTwo cases of middle-aged men with hypertension, hyperlipidemia, and diabetes mellitus presented with fluctuating right-sided weakness, numbness, and dysarthria.DiagnosesThese two patients were diagnosed with CWS.InterventionsRecombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis (0.9 mg/kg) was administered first and treated with aspirin (100 mg) and clopidogrel (75 mg) after 24 h of rt-PA for 21 days following by aspirin (100 mg) alone.OutcomesBoth 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.LessonsEarly recognition and rt-PA/dual antiplatelet treatment may be an effective strategy for patients with CWS.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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