Background and Purpose-Approximately 25% of ischemic stroke patients awaken with their deficits. The last-seen-normal time is defined as the time the patient went to sleep, which places these patients outside the window for thrombolysis. The purpose of this study was to describe our center's experience with off-label, compassionate thrombolysis for wake-up stroke (WUS) patients.

Background Intra-arterial recanalization therapy (IAT) is increasingly utilized for acute stroke. Despite high rates of recanalization the outcome is variable. We attempted to identify predictors of outcome that will enable better patient selection for IAT. Methods All patients who underwent IAT at the UT Houston Stroke Center were reviewed. Poor outcome was defined as modified Rankin Scale score 4–6 on hospital discharge. Findings were validated in an independent dataset of 175 patients from UCLA Stroke Center Results 190 patients were identified. Mean age 62, median baseline NIHSS .18. Recanalization rate 75%, symptomatic hemorrhage rate 6%, and poor outcome rate 66%. Variables associated with poor outcome were: age, baseline NIHSS, admission glucose, diabetes, heart disease, previous stroke and the absence of mismatch on the pre-treatment MRI. Logistic regression identified three variables independently associated with poor outcome: age (p=0.049, OR=1.028), NIHSS (p=0.013, OR=1.084), admission glucose (p=0.031, OR=1.011). Using this data, we devised the Houston IAT (HIAT) score: 1 point for age>75; 1 for NIHSS>18 and 1 point for glucose>150mg/dL (range 0 to 3). The percentage of poor outcome by HIAT score was: score of 0: 44%; 1: 67%; 2: 97%; 3: 100%. Recanalization rates were similar across the scores (p=0.4). Applying HIAT to the external cohort showed comparable trends in outcome and nearly identical rates in the HIAT 3 tier. Conclusions The HIAT score estimates the chances of poor outcome after IAT even with recanalization. It may be useful in comparing cohorts of patients and when assessing the results of clinical trials.

Objective-Intraventricular extension of intracerebral hemorrhage (IVH) is an independent predictor of poor outcome. IVH volume may be important in outcome prediction and management; however, it is difficult to measure routinely.Design and Patients-We reviewed the charts and computed tomographies of a cohort of consecutive patients with IVH. The cohort was divided into two groups: index and validation by random sampling. IVH and intracerebral hemorrhage (ICH) volume were measured manually in all patients. IVH was also graded using a simple classification system termed IVH score (IVHS). Clinical outcome was determined by the modified Rankin Scale (mRS) at discharge and in-hospital death. Poor outcome was defined as mRS 4-6.Main Results-One hundred seventy-five patients were analyzed, 92 in the index group and 83 in the validation group. Exponential regression yielded the following formula for estimating IVH volume (mL): eÎVHS/5 (R 2 = .75, p < 0.001). The IVH estimation formula was then verified in the validation group (R 2 = .8, p < 0.001). The following correlations with mRS were obtained: IVH volume R = .305; ICH volume R = .468; total volume [TV] R = .571 (p < 0.001 for all three correlations). Partial correlation of TV with mRS controlling for ICH volume yielded R = .3 for TV (p < 0.001). Logistic regression model comparing ICH and TV association with poor outcome yielded the following: ICH odds ratio = 5.2, 95% confidence interval 2.3-11.6, p < 0.001; TV odds ratio = 41.6, 95% confidence interval 9.6-180.6, p < 0.001. Substituting TV for ICH volume in the ICH score resulted in a significant increase in the specificity from 64% to 87% for predicting mortality. (7) is a known independent predictor of poor outcome (1,(7)(8)(9)(10)(11)(12)(13)(14) and several studies have demonstrated a direct relation between IVH volume and poor outcome or mortality (20,25,26). Yet, most studies investigating IVH volume use sophisticated and time-consuming volumetric analyses (15) that are impractical for routine clinical use and clinicians still lack a method for easily obtaining an estimate of the IVH volume. The purpose of this study was to create a useful tool for rapid determination of IVH volume and to further explore the prognostic significance of IVH volume. Specifically, we tried to assess the relationship between IVH volume or total volume (TV the combination of ICH and IVH volume) and clinical outcome. Conclusions-IVHS METHODS Study Design and PopulationA retrospective chart review of all patients admitted to our stroke center between April 2003 and June 2006 with the diagnosis of ICH. Patients were included if they suffered from spontaneous nontraumatic ICH and had evidence of IVH on computed tomography (CT) during admission done within 24 hours of onset. Patients were excluded from the analysis if they had ICH secondary to vascular malformations, tumor, or hemorrhagic conversion of an infarct. All CT scans were done using identical technique (slice thickness 5 mm, gantry tilt −16). We also excluded patient...