ABSTRACT NUMBER: ESOC2026A1622 CAPSULAR WARNING SYNDROME PRESENTING WITH RECURRENT APHASIA: A CASE REPORT

Abstract Background and aims Capsular warning syndrome (CWS) is characterized by recurrent stereotyped episodes of transient motor and/or sensory deficits, typically related to small perforating vessel disease. Cortical symptoms, such as aphasia, are traditionally considered to be exclusionary. We present a case of CWS with recurrent aphasia, highlighting the role of cortico-subcortical network disruption in small, deep infarcts. Methods We report the case of a 57-year-old woman, a smoker without other vascular risk factors, who presented with sudden-onset episodes of right-sided weakness associated with impaired language production, each lasting approximately 20 min. Five stereotyped, self-limited episodes occurred over a short period, consistently in the context of elevated blood pressure values. Results Given the suspected vascular etiology, a stroke code was activated for the patient. Multimodal CT revealed no acute ischemic lesions, large vessel occlusions, or perfusion abnormalities. Subsequent brain MRI revealed a focal area of diffusion restriction with corresponding ADC hypointensity and no FLAIR changes, consistent with acute ischemia involving the left caudate nucleus with extension to the ipsilateral corona radiata without cortical involvement. Conclusions This case supports the notion that capsular warning syndrome may present with symptoms traditionally considered cortical, such as aphasia. Subcortical ischemic lesions can disrupt cortico-subcortical language networks, leading to clinically significant impairments. Conflict of interest Irene Díaz-Díaz: nothing to disclose Figure 1 - belongs to Results