SHM Converge Scientific Abstract ePoster Gallery-The Stuttering Stroke, Course and Approach

Pdf Summary

An 85-year-old man with untreated hypertension and aspirin use presented with recurrent, transient right-sided weakness over three days. His initial NIH Stroke Scale score was 0, and a noncontrast CT head showed no acute intracranial abnormality. Because he was outside the thrombolysis window, he was treated with aspirin and clopidogrel loading doses and managed with permissive hypertension for 48 hours.<br /><br />During hospitalization, he continued to have repeated brief episodes of right hemiparesis, prompting multiple stroke alerts. Neurologic deficits fluctuated, with NIHSS scores ranging from 1 to 4. MRI brain ultimately revealed an acute/subacute infarct in the left putamen in the left MCA territory, consistent with a lacunar stroke with a “stuttering” presentation, also known as capsular warning syndrome. On hospital day four, his weakness became persistent, and repeat CT showed a subacute infarct extending through the left periventricular white matter into the lentiform nucleus.<br /><br />The case highlights that lacunar strokes, caused by small vessel disease, can present with transient, waxing-and-waning deficits that may mimic recurrent TIAs and trigger repeated stroke evaluations. These infarcts are often small and may be difficult to detect early on imaging. The presentation may either resolve or progress to a completed stroke.<br /><br />There are no definitive clinical trials guiding management, but proposed approaches include dual antiplatelet therapy, statin therapy, blood pressure augmentation in selected patients, and repeat imaging if symptoms worsen to exclude hemorrhagic transformation. The patient was discharged on dual antiplatelet therapy for 21 days followed by single antiplatelet therapy, along with high-dose statin therapy.

Asset Subtitle

Peter D. Le

Meta Tag

Author List Davis Sugar, James Schmidley, Peter D. Le

Category Clinical Vignettes

Concept Lacunar infarct

Concept Capsular Warning Syndrome

Concept Stuttering Stroke

Concept Transient Ischemic Attack

Concept Pure Motor Hemiparesis

Distinguished Non-Finalist

Presenter Organization Virginia Tech Carilion (VTC)

Presenting Author Peter D. Le

Track Adult

Keywords

capsular warning syndrome

lacunar stroke

stuttering stroke

transient right-sided weakness

small vessel disease

left putamen infarct

left MCA territory

dual antiplatelet therapy

permissive hypertension

recurrent TIAs

Lacunar infarct

Capsular Warning Syndrome

Stuttering Stroke

Transient Ischemic Attack

Pure Motor Hemiparesis