INTRODUCTION: Intravenous tissue plasminogen activator (IV tPA) has revolutionized the treatment of acute ischemic stroke. However, there remain situations when administration is relatively contraindicated (eg. , arrival outside the accepted treatment window, mild or rapidly improving symptoms). Optimal treatment in these situations is less clear. CASE SERIES: We describe a small case series of 7 patients presenting with fluctuating symptoms concerning for a capsular warning syndrome (acute isolated motor and/or sensory deficits without cortical signs, usually attributed to small vessel pathology), often referred to as a "stuttering lacune", who were orally loaded with 300mg of clopidogrel. Four of the 7 patients had complete resolution of their symptoms following the load. The others experienced stabilization of their deficits, but were discharged with mild persistent symptoms. Four patients had evidence of diffusion bright lesions on MRI, while the others had no evidence of infarction. None of the patients experienced hemorrhagic conversion of their infarct or other bleeding complications. CONCLUSION: Our experience suggests that acutely loading with clopidogrel may be both effective and well tolerated in the treatment of stuttering lacunes.
INTRODUCTION: Intravenous tissue plasminogen activator (IV tPA) has revolutionized the treatment of acute ischemic stroke. However, there remain situations when administration is relatively contraindicated (eg. , arrival outside the accepted treatment window, mild or rapidly improving symptoms). Optimal treatment in these situations is less clear. CASE SERIES: We describe a small case series of 7 patients presenting with fluctuating symptoms concerning for a capsular warning syndrome (acute isolated motor and/or sensory deficits without cortical signs, usually attributed to small vessel pathology), often referred to as a "stuttering lacune", who were orally loaded with 300mg of clopidogrel. Four of the 7 patients had complete resolution of their symptoms following the load. The others experienced stabilization of their deficits, but were discharged with mild persistent symptoms. Four patients had evidence of diffusion bright lesions on MRI, while the others had no evidence of infarction. None of the patients experienced hemorrhagic conversion of their infarct or other bleeding complications. CONCLUSION: Our experience suggests that acutely loading with clopidogrel may be both effective and well tolerated in the treatment of stuttering lacunes.
Authors: Oscar R Benavente; Robert G Hart; Leslie A McClure; Jeffrey M Szychowski; Christopher S Coffey; Lesly A Pearce Journal: N Engl J Med Date: 2012-08-30 Impact factor: 91.245
Authors: Marc I Chimowitz; Michael J Lynn; Colin P Derdeyn; Tanya N Turan; David Fiorella; Bethany F Lane; L Scott Janis; Helmi L Lutsep; Stanley L Barnwell; Michael F Waters; Brian L Hoh; J Maurice Hourihane; Elad I Levy; Andrei V Alexandrov; Mark R Harrigan; David Chiu; Richard P Klucznik; Joni M Clark; Cameron G McDougall; Mark D Johnson; G Lee Pride; Michel T Torbey; Osama O Zaidat; Zoran Rumboldt; Harry J Cloft Journal: N Engl J Med Date: 2011-09-07 Impact factor: 91.245
Authors: Deepak L Bhatt; Keith A A Fox; Werner Hacke; Peter B Berger; Henry R Black; William E Boden; Patrice Cacoub; Eric A Cohen; Mark A Creager; J Donald Easton; Marcus D Flather; Steven M Haffner; Christian W Hamm; Graeme J Hankey; S Claiborne Johnston; Koon-Hou Mak; Jean-Louis Mas; Gilles Montalescot; Thomas A Pearson; P Gabriel Steg; Steven R Steinhubl; Michael A Weber; Danielle M Brennan; Liz Fabry-Ribaudo; Joan Booth; Eric J Topol Journal: N Engl J Med Date: 2006-03-12 Impact factor: 91.245