{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T13:08:28Z","timestamp":1780664908913,"version":"3.54.1"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:sec>\n            <jats:title>Introduction:<\/jats:title>\n            <jats:p>Crescendo transient ischemic attacks or \u201cStroke Warning Syndromes\u201d 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Case Report:<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/nrl.0000000000000092","type":"journal-article","created":{"date-parts":[[2016,11,1]],"date-time":"2016-11-01T10:22:11Z","timestamp":1477995731000},"page":"93-96","source":"Crossref","is-referenced-by-count":10,"title":["Pontine Warning Syndrome"],"prefix":"10.1097","volume":"21","author":[{"given":"Alejandro","family":"Enriquez-Marulanda","sequence":"first","affiliation":[{"name":"Fundaci\u00f3n Cl\u00ednica Valle del Lili, Neurology Department"},{"name":"Universidad ICESI"},{"name":"Centro de Investigaciones Cl\u00ednicas, Cali, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Amaya-Gonzalez","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Cl\u00ednica Valle del Lili, Neurology Department"},{"name":"Universidad ICESI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge L.","family":"Orozco","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Cl\u00ednica Valle del Lili, Neurology Department"},{"name":"Universidad ICESI"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20230929","doi-asserted-by":"crossref","first-page":"2064","DOI":"10.1161\/STR.0b013e318296aeca","article-title":"An updated definition of stroke for the 21st century. A statement for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"44","author":"Sacco","year":"2013","journal-title":"Stroke"},{"key":"R2-20230929","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/j.emc.2012.06.006","article-title":"Stroke mimics","volume":"30","author":"Magauran","year":"2012","journal-title":"Emerg Med Clin"},{"key":"R3-20230929","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1136\/practneurol-2013-000782","article-title":"Transient ischaemic attacks: mimics and chameleons","volume":"14","author":"Nadarajan","year":"2014","journal-title":"Pract Neurol"},{"key":"R4-20230929","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1212\/WNL.43.5.957","article-title":"The capsular warning syndrome pathogenesis and clinical features","volume":"43","author":"Donnan","year":"1993","journal-title":"Neurology"},{"key":"R5-20230929","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.jns.2013.05.027","article-title":"Stroke warning syndrome: 18 new cases","volume":"331","author":"Tassi","year":"2013","journal-title":"J Neurol Sci"},{"key":"R6-20230929","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1161\/01.STR.24.5.762","article-title":"Capsular warning syndrome preceding pontine infarction","volume":"24","author":"Farrar","year":"1993","journal-title":"Stroke"},{"key":"R7-20230929","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1111\/j.1552-6569.2001.tb00008.x","article-title":"Localization of clinical syndromes using DWI: two examples of the \u201ccapsular\u201d warning syndrome","volume":"11","author":"Oliveira-Filho","year":"2001","journal-title":"J Neuroimaging Off J Am Soc Neuroimaging"},{"key":"R8-20230929","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1159\/000047666","article-title":"Detection of acute pontine infarction by diffusion-weighted MRI in capsular warning syndrome","volume":"11","author":"Benito-Le\u00f3n","year":"2001","journal-title":"Cerebrovasc Dis"},{"key":"R9-20230929","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000073891","article-title":"Diffusion-weighted MRI findings in patients with capsular warning syndrome","volume":"17","author":"Staaf","year":"2004","journal-title":"Cerebrovasc Dis Basel Switz"},{"key":"R10-20230929","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.jns.2011.10.007","article-title":"Callosal warning syndrome","volume":"314","author":"Nandhagopal","year":"2012","journal-title":"J Neurol Sci"},{"key":"R11-20230929","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1001\/archneur.65.10.1375","article-title":"Pontine warning syndrome","volume":"65","author":"Saposnik","year":"2008","journal-title":"Arch Neurol"},{"key":"R12-20230929","first-page":"30","article-title":"Penetrating artery territory pontine infarction","volume":"8","author":"Field","year":"2011","journal-title":"Rev Neurol Dis"},{"key":"R13-20230929","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.jstrokecerebrovasdis.2009.06.008","article-title":"Pontine warning syndrome: case series and review of literature","volume":"19","author":"Muengtaweepongsa","year":"2010","journal-title":"J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc"},{"key":"R14-20230929","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/1471-2377-10-55","article-title":"Patient with pontine warning syndrome and bilateral posterior internuclear ophthalmoplegia: case report","volume":"10","author":"Huang","year":"2010","journal-title":"BMC Neurol"},{"key":"R15-20230929","doi-asserted-by":"crossref","first-page":"15269","DOI":"10.1038\/srep15269","article-title":"Characteristics of dynamic cerebral autoregulation in cerebral small vessel disease: diffuse and sustained","volume":"5","author":"Guo","year":"2015","journal-title":"Sci Rep"},{"key":"R16-20230929","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/S0072-9752(08)01914-3","article-title":"Cerebral vascular dysregulation in the ischemic brain","volume":"92","author":"Kunz","year":"2009","journal-title":"Handb Clin Neurol"},{"key":"R17-20230929","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1113\/jphysiol.2013.268953","article-title":"Integrative regulation of human brain blood flow","volume":"592","author":"Willie","year":"2014","journal-title":"J Physiol"},{"key":"R18-20230929","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1001\/jamaneurol.2015.3772","article-title":"Effect of hemodynamics on stroke risk in symptomatic atherosclerotic vertebrobasilar occlusive disease","volume":"73","author":"Amin-Hanjani","year":"2016","journal-title":"JAMA Neurol"}],"container-title":["The Neurologist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00127893-201611000-00003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T09:48:38Z","timestamp":1695980918000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00127893-201611000-00003"}},"subtitle":["A Chameleon of Ischemic Stroke"],"short-title":[],"issued":{"date-parts":[[2016,11]]},"references-count":18,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2016]]}},"URL":"https:\/\/doi.org\/10.1097\/nrl.0000000000000092","relation":{},"ISSN":["1074-7931"],"issn-type":[{"value":"1074-7931","type":"print"}],"subject":[],"published":{"date-parts":[[2016,11]]}}}