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J Neurol Sci. 2013 Aug 15;331(1-2):168-71. doi: 10.1016/j.jns.2013.05.027. Epub 2013 Jun 10.

Stroke warning syndrome: 18 new cases.

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Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy.



Stroke warning syndrome (SWS) is a rare cause of stroke characterized by recurrent and short-lasting episodes of transient focal neurological deficits leading up to infarction. On the basis of clinical findings and neuroimaging, it can be capsular, pontine, or callosal. The aim of this study is to evaluate the prevalence of SWS in patients admitted to our Stroke Unit for an ischemic stroke and to look for the difference in outcome between patients treated or not with systemic thrombolysis by intravenous recombinant tissue plasminogen activator (IV-rtPA).


Among the 967 patients admitted to our Stroke Unit between April 2008 and January 2013 for ischemic stroke, we identified 18 patients with SWS. Nine patients underwent IV-rtPA (IV Group) and the other 9 (No IV Group) other therapies.


The prevalence of SWS in our population was 1.8%. The most common risk factors were hypertension and dyslipidemia in both groups. A good outcome at 3-month follow-up (modified Rankin Scale 0-2) was found in 3 patients (33%) in IV Group and in 5 patients (55%) in No IV Group.


SWS is an under-recognized syndrome. Intravenous rt-PA treatment seems to have lower efficacy than in other subtypes of strokes, but none of the patients with SWS undergoing treatment presented haemorrhagic transformation or other complications.


Capsular warning syndrome; Intravenous thrombolysis; Pontine warning syndrome; Small vessel diseases; Stroke warning syndrome; Transient ischemic attack

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