{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:35:01Z","timestamp":1787070901826,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:p>Capsular warning syndrome (CWS) is a rare condition marked by recurrent, stereotypical transient ischemic attacks (TIAs) affecting the face, arm, and leg, without cortical involvement. It is associated with a high risk of a full-blown stroke within 7 days. The exact pathophysiological mechanism and optimal management strategies remain debated. It is crucial to distinguish CWS from crescendo TIAs and consider reperfusion therapy if new episodes occur within the therapeutic window for systemic reperfusion, in order to prevent a disabling stroke. We present the case of a 53-year-old male who arrived at the emergency department (ED) with right hemiparesis and facial weakness lasting for 1 h. He had experienced four recurrent, stereotypical episodes over the past 7 h and was diagnosed with a TIA, despite being within the therapeutic window for thrombolysis. He was started on dual antiplatelet therapy, high-dose statins, and management of other vascular risk factors. However, within 24 h, his condition progressed to a complete stroke with severe hemiparesis and facial weakness. Magnetic resonance imaging confirmed infarction in the left hemisphere, while a computed tomography angiogram was normal. This case underscores the importance of prompt recognition of CWS in the ED, enabling activation of stroke services and the consideration of reperfusion therapy when appropriate, to minimize the risk of a disabling stroke.<\/jats:p>","DOI":"10.4103\/tjem.tjem_220_24","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T10:00:16Z","timestamp":1751364016000},"page":"246-249","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Capsular warning syndrome: Nighttime blood pressure drops, clinical awareness, and therapeutic approach"],"prefix":"10.4103","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2608-1107","authenticated-orcid":false,"given":"Erum","family":"Shariff","sequence":"first","affiliation":[{"name":"Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7339-2955","authenticated-orcid":false,"given":"Rizwana","family":"Shahid","sequence":"additional","affiliation":[{"name":"Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"key":"R1-20260422","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1212\/WNL.0b013e31826c1af8","article-title":"Population-based study of capsular warning syndrome and prognosis after early recurrent TIA","volume":"79","author":"Paul","year":"2012","journal-title":"Neurology"},{"key":"R2-20260422","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1159\/000525954","article-title":"Capsular warning syndrome: Features, risk profile, and prognosis in a large prospective TIA cohort","volume":"52","author":"Foschi","year":"2023","journal-title":"Cerebrovasc Dis"},{"key":"R3-20260422","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1186\/s12883-019-1522-0","article-title":"Capsular warning syndrome: Clinical analysis and treatment","volume":"19","author":"He","year":"2019","journal-title":"BMC Neurol"},{"key":"R4-20260422","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s12245-023-00541-w","article-title":"Capsular warning syndrome-a case of atrial fibrillation and corona radiata infarct","volume":"16","author":"Tan","year":"2023","journal-title":"Int J Emerg Med"},{"key":"R5-20260422","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":"R6-20260422","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":"R7-20260422","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.jns.2017.08.008","article-title":"Capsular warning syndrome: The role of blood pressure","volume":"381","author":"Ladeira","year":"2017","journal-title":"J Neurol Sci"},{"key":"R8-20260422","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1159\/000080356","article-title":"Relevance of transient ischemic attack to early neurological recovery after nonlacunar ischemic stroke","volume":"18","author":"Arboix","year":"2004","journal-title":"Cerebrovasc Dis"},{"key":"R9-20260422","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1159\/000070121","article-title":"The role of blood pressure in lacunar strokes preceded by TIAs","volume":"16","author":"Lalive","year":"2003","journal-title":"Cerebrovasc Dis"},{"key":"R10-20260422","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jns.2019.04.009","article-title":"Can we stop the stuttering in stroke? Interventions in 40 patients with acute lacunes","volume":"401","author":"Hawkes","year":"2019","journal-title":"J Neurol Sci"},{"key":"R11-20260422","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1161\/01.STR.27.8.1319","article-title":"Nocturnal blood pressure and silent cerebrovascular lesions in elderly Japanese","volume":"27","author":"Watanabe","year":"1996","journal-title":"Stroke"},{"key":"R12-20260422","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1161\/01.STR.0000014584.17714.2E","article-title":"Effects of induced hypertension on intracranial pressure and flow velocities of the middle cerebral arteries in patients with large hemispheric stroke","volume":"33","author":"Schwarz","year":"2002","journal-title":"Stroke"},{"key":"R13-20260422","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1111\/ijs.12432","article-title":"Clinical characteristics and outcome of the capsular warning syndrome: A multicenter study","volume":"10","author":"Camps-Renom","year":"2015","journal-title":"Int J Stroke"},{"key":"R14-20260422","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1001\/jamaneurol.2019.0351","article-title":"Functional outcome of intravenous thrombolysis in patients with lacunar infarcts in the WAKE-UP trial","volume":"76","author":"Barow","year":"2019","journal-title":"JAMA Neurol"},{"key":"R15-20260422","doi-asserted-by":"crossref","first-page":"5039","DOI":"10.2147\/IJGM.S326301","article-title":"The J-curve association between blood pressure and mortality in stroke survivors","volume":"14","author":"Yin","year":"2021","journal-title":"Int J Gen Med"}],"container-title":["Turkish Journal of Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/tjem.tjem_220_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:38:36Z","timestamp":1787067516000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/tjem.tjem_220_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":15,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/tjem.tjem_220_24","relation":{},"ISSN":["2452-2473","2452-2473"],"issn-type":[{"value":"2452-2473","type":"print"},{"value":"2452-2473","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]},"assertion":[{"value":"2024-10-17","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-10","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}