What to do With Wake-Up Stroke

Rubin, Mark N.; Barrett, Kevin M.

doi:10.1177/1941874415576204

Cited by 46 publications

(40 citation statements)

References 92 publications

(109 reference statements)

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“…Patients who were last seen well > 9 h were excluded. This may explain why we found a relatively low time between last seen well and CT for the WUS patients and a relatively low percentage of WUS patients compared to other cohorts [7]. However, the cohort most similar to ours also found similar results [23].…”

Section: Discussionsupporting

confidence: 54%

Wake-Up Stroke versus Stroke with Known Onset Time: Clinical and Multimodality CT Imaging Characteristics

et al. 2018

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Background: Current guidelines for the treatment of acute ischemic stroke are mainly based on the time between symptom onset and initiation of treatment. This time is unknown in patients with wake-up stroke (WUS). We investigated clinical and multimodality CT imaging characteristics on admission in patients with WUS and in patients with a stroke with a known onset time. Methods: All patients were selected from a large prospective cohort study (Dutch acute stroke study). WUS patients last seen well > 4.5 and ≤4.5 h were separately compared to patients with a known onset time ≤4.5 h. In addition, WUS patients with a proximal occlusion of the anterior circulation last seen well > 6 and ≤6 h were separately compared to patients with a known onset time ≤6 h and a proximal occlusion. National Institute of Health Stroke Score, age, gender, history of atrial fibrillation, non-contrast CT (NCCT) Alberta Stroke Program Early CT Score (ASPECTS), CT-perfusion abnormalities, proximal occlusions, and collateral filling on CT angiography were compared between groups using the Mann-Whitney U test and Fisher’s exact test. Results: WUS occurred in 149/1,393 (10.7%) patients. Admission clinical and imaging characteristics of WUS patients last seen well > 4.5 h (n = 81) were not different from WUS patients last seen well ≤4.5 h (n = 68). Although WUS patients last seen well > 4.5 h had a significantly lower NCCT ASPECTS than patients with a known time of stroke symptom onset of ≤4.5 h (n = 1,026), 85.2% had an NCCT ASPECTS > 7 and 75% had a combination of favorable ASPECTS > 7 and good collateral filling. There were no statistically significant differences between the admission clinical and imaging characteristics of WUS patients with proximal occlusions last seen well > 6 h (n = 23), last seen well ≤6 h (n = 40), and patients with a known time to stroke symptom onset ≤6 h (n = 399). Of all WUS patients with proximal occlusions last seen well > 6 h, only 4.3% had severe ischemia (ASPECTS < 5), 13 (56.5%) had ASPECTS > 7 and good collateral filling. Conclusions: There are only minor differences between clinical and imaging characteristics of WUS patients and patients who arrive in the hospital within the time criteria for intravenous or endovascular treatment. Therefore, CT imaging may help to identify WUS patients who would benefit from treatment and rule out those patients with severe ischemia and poor collaterals.

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Section: Discussionsupporting

confidence: 54%

Wake-Up Stroke versus Stroke with Known Onset Time: Clinical and Multimodality CT Imaging Characteristics

et al. 2018

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“…After years of time window based recanalization therapies [1][2][3] for patients presenting with acute ischaemic stroke (AIS), the recently published results of the DAWN trial [4] just proved the high value of imaging based selection for treating stroke patients with a late or uncertain time of onset. In fact, the increasing use of advanced imaging has allowed a better understanding of the physiopathological processes occurring during stroke [5][6][7][8]. In 2011, Thomalla et al [9] established that a diffusion weighted imaging/ fluid attenuated inversion recovery (DWI-FLAIR) mismatch could help identify patients within 4.5 h of symptom onset with a positive predictive value of 0.83 and specificity of 0.78, which were even higher when extended to 6 h, respectively 0.95 and 0.85.…”

Section: Introductionmentioning

confidence: 99%

Unknown‐onset strokes with anterior circulation occlusion treated by thrombectomy after DWI‐FLAIR mismatch selection

Escalard

Gory

Kyheng

et al. 2018

Euro J of Neurology

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“…36 A few CT-based studies reported similarity in early ischemic changes observed in both WUS and non-WUS. [37][38][39][40] Roveri et al compared early ischemic changes on CT imaging in WUS and non-WUS patients with similar clinical and demographic characteristics. There was a comparable degree of early ischemic change as evidenced by similar amounts of parenchymal hypoattenuation, blurring of the graywhite junction, and swelling as judged by the Alberta Stroke Program Early CT Score (ASPECTS), in the baseline CT scan in both groups.…”

Section: Neuroimaging In Wusmentioning

confidence: 99%

Pathophysiologic mechanisms, neuroimaging and treatment in wake-up stroke

et al. 2019

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Wake-up stroke (WUS) or ischemic stroke occurring during sleep accounts for 14%–29.6% of all ischemic strokes. Management of WUS is complicated by its narrow therapeutic time window and attributable risk factors, which can affect the safety and efficacy of administering intravenous (IV) tissue plasminogen activator (t-PA). This manuscript will review risk factors of WUS, with a focus on obstructive sleep apnea, potential mechanisms of WUS, and evaluate studies assessing safety and efficacy of IV t-PA treatment in WUS patients guided by neuroimaging to estimate time of symptom onset. The authors used PubMed (1966 to March 2018) to search for the term “Wake-Up Stroke” cross-referenced with “pathophysiology,” ‘‘pathogenesis,” “pathology,” “magnetic resonance imaging,” “obstructive sleep apnea,” or “treatment.” English language Papers were reviewed. Also reviewed were pertinent papers from the reference list of the above-matched manuscripts. Studies that focused only on acute Strokes with known-onset of symptoms were not reviewed. Literature showed several potential risk factors associated with increased risk of WUS. Although the onset of WUS is unknown, a few studies investigated the potential benefit of magnetic resonance imaging (MRI) in estimating the age of onset which encouraged conducting clinical trials assessing the efficacy of MRI-guided thrombolytic therapy in WUS.

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What to do With Wake-Up Stroke

Cited by 46 publications

References 92 publications

Wake-Up Stroke versus Stroke with Known Onset Time: Clinical and Multimodality CT Imaging Characteristics

Wake-Up Stroke versus Stroke with Known Onset Time: Clinical and Multimodality CT Imaging Characteristics

Unknown‐onset strokes with anterior circulation occlusion treated by thrombectomy after DWI‐FLAIR mismatch selection

Pathophysiologic mechanisms, neuroimaging and treatment in wake-up stroke

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