Recurrent transitory attacks with cytotoxic edema could benefit from thrombolysis
Dublin Core
Title
Recurrent transitory attacks with cytotoxic edema could benefit from thrombolysis
Subject
Stroke, Transitory ischemic attack, Thrombolysis, Cerebral MRI, Atrial fibrillation
Description
We read with interest the article by Tan et al. about a
65-year-old male with ten transitory ischemic attacks
(TIAs) within three hours, clinically manifesting as dys-
arthria and right-sided hemiparesis, each lasting approxi-
mately 10 min [1]. ECG showed newly diagnosed atrial
fibrillation (AF). Cerebral computed tomography (CCT)
showed an old left, lacunar striato-capsular infarct and
computed tomography angiography (CTA) showed only
mild atherosclerosis [1]. Magnetic resonance imaging
(MRI) showed a small acute infarct in the left corona
radiata three hours after onset [1]. The patient recovered
completely under therapy initially with acetyl-salicylic
acid (ASS, 300 mg), clopidogrel (300 mg), and “aggressive
hydration”, which was replaced by apixaban 10 mg/d three
days after onset [1]. The study is impressive, but several
points require discussion.
The major limitation of the study is that the patient did
not have capsular warning syndrome (CWS) [1]. “Cap-
sule” refers to the internal capsule. However, MRI showed
an ischemic lesion in the left corona radiata, which is dis-
tinct from the internal capsule. Therefore, the diagnosis
of CWS is not justified. A second argument against CWS
is that dysarthria and hemiparesis are not necessarily due
65-year-old male with ten transitory ischemic attacks
(TIAs) within three hours, clinically manifesting as dys-
arthria and right-sided hemiparesis, each lasting approxi-
mately 10 min [1]. ECG showed newly diagnosed atrial
fibrillation (AF). Cerebral computed tomography (CCT)
showed an old left, lacunar striato-capsular infarct and
computed tomography angiography (CTA) showed only
mild atherosclerosis [1]. Magnetic resonance imaging
(MRI) showed a small acute infarct in the left corona
radiata three hours after onset [1]. The patient recovered
completely under therapy initially with acetyl-salicylic
acid (ASS, 300 mg), clopidogrel (300 mg), and “aggressive
hydration”, which was replaced by apixaban 10 mg/d three
days after onset [1]. The study is impressive, but several
points require discussion.
The major limitation of the study is that the patient did
not have capsular warning syndrome (CWS) [1]. “Cap-
sule” refers to the internal capsule. However, MRI showed
an ischemic lesion in the left corona radiata, which is dis-
tinct from the internal capsule. Therefore, the diagnosis
of CWS is not justified. A second argument against CWS
is that dysarthria and hemiparesis are not necessarily due
Creator
Josef Finsterer1* and Sounira Mehri2
Source
https://doi.org/10.1186/s12245-024-00601-9
Date
2024
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Josef Finsterer1* and Sounira Mehri2, “Recurrent transitory attacks with cytotoxic edema could benefit from thrombolysis,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12291.