M C Denny1, A K Boehme2, A M Dorsey3, A J George3, A D Yeh3, K C Albright4, S Martin-Schild3. 1. Department of Neurology, Medstar Georgetown University Hospital, Washington, DC; Stroke Program, Department of Neurology, Tulane University School of Medicine, New Orleans, LA. 2. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham; Department of Neurology, School of Medicine, University of Alabama at Birmingham. 3. Stroke Program, Department of Neurology, Tulane University School of Medicine, New Orleans, LA. 4. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham; Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE); Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health and Health Disparities Research Center (MHRC); Department of Neurology, School of Medicine, University of Alabama at Birmingham.
Abstract
BACKGROUND: Stroke symptoms noticed upon waking, wake-up stroke, account for up to a quarter of all acute ischemic strokes. Patients with wake-up stroke, however, are often excluded from thrombolytic therapy. METHODS: Using our prospectively collected stroke registry, wake-up stroke and known-onset morning strokes were identified. Wakeup stroke was defined as a patient who was asleep >3 hours and first noted stroke symptoms upon awakening between 0100 and 1100. Known-onset morning stroke was defined as a patient who had symptom onset while awake during the same time interval. We compared wake-up stoke to known-onset morning stroke with respect to patient demographics, stroke severity, etiology and outcomes. RESULTS: One-quarter of patients with acute ischemic strokes (391/1415) had documented time between 0100 and 1100 of symptom onset: 141 (36%) wake-up strokes and 250 (64%) known-onset morning strokes. No difference in baseline characteristics, stroke severity, stroke etiology, neurologic deterioration, discharge disposition or functional outcome was detected. Known-onset morning stroke patients were significantly more likely to get thrombolytic therapy and have higher risk of in-hospital mortality. Wake-up stroke patients tended to be older, have higher diastolic blood pressure and have longer length of hospital stay. DISCUSSION: While patients with wake-up stroke were similar to patients with known-onset morning stroke in many respects, patients with known onset morning stroke were significantly more likely to get treated with thrombolytic therapy and have higher in-hospital mortality.
BACKGROUND:Stroke symptoms noticed upon waking, wake-up stroke, account for up to a quarter of all acute ischemic strokes. Patients with wake-up stroke, however, are often excluded from thrombolytic therapy. METHODS: Using our prospectively collected stroke registry, wake-up stroke and known-onset morning strokes were identified. Wakeup stroke was defined as a patient who was asleep >3 hours and first noted stroke symptoms upon awakening between 0100 and 1100. Known-onset morning stroke was defined as a patient who had symptom onset while awake during the same time interval. We compared wake-up stoke to known-onset morning stroke with respect to patient demographics, stroke severity, etiology and outcomes. RESULTS: One-quarter of patients with acute ischemic strokes (391/1415) had documented time between 0100 and 1100 of symptom onset: 141 (36%) wake-up strokes and 250 (64%) known-onset morning strokes. No difference in baseline characteristics, stroke severity, stroke etiology, neurologic deterioration, discharge disposition or functional outcome was detected. Known-onset morning strokepatients were significantly more likely to get thrombolytic therapy and have higher risk of in-hospital mortality. Wake-up strokepatients tended to be older, have higher diastolic blood pressure and have longer length of hospital stay. DISCUSSION: While patients with wake-up stroke were similar to patients with known-onset morning stroke in many respects, patients with known onset morning stroke were significantly more likely to get treated with thrombolytic therapy and have higher in-hospital mortality.
Authors: James E Siegler; Amelia K Boehme; Andre D Kumar; Michael A Gillette; Karen C Albright; Sheryl Martin-Schild Journal: J Stroke Cerebrovasc Dis Date: 2012-06-21 Impact factor: 2.136
Authors: J Mackey; D Kleindorfer; H Sucharew; C J Moomaw; B M Kissela; K Alwell; M L Flaherty; D Woo; P Khatri; O Adeoye; S Ferioli; J C Khoury; R Hornung; J P Broderick Journal: Neurology Date: 2011-05-10 Impact factor: 9.910
Authors: Werner Hacke; Markku Kaste; Erich Bluhmki; Miroslav Brozman; Antoni Dávalos; Donata Guidetti; Vincent Larrue; Kennedy R Lees; Zakaria Medeghri; Thomas Machnig; Dietmar Schneider; Rüdiger von Kummer; Nils Wahlgren; Danilo Toni Journal: N Engl J Med Date: 2008-09-25 Impact factor: 91.245
Authors: Götz Thomalla; Jochen B Fiebach; Leif Østergaard; Salvador Pedraza; Vincent Thijs; Norbert Nighoghossian; Pascal Roy; Keith W Muir; Martin Ebinger; Bastian Cheng; Ivana Galinovic; Tae-Hee Cho; Josep Puig; Florent Boutitie; Claus Z Simonsen; Matthias Endres; Jens Fiehler; Christian Gerloff Journal: Int J Stroke Date: 2013-03-12 Impact factor: 5.266
Authors: Pablo Hervella; María Luz Alonso-Alonso; María Pérez-Mato; Manuel Rodríguez-Yáñez; Susana Arias-Rivas; Iria López-Dequidt; José M Pumar; Tomás Sobrino; Francisco Campos; José Castillo; Ramón Iglesias-Rey Journal: BMC Neurol Date: 2022-06-09 Impact factor: 2.903
Authors: Jan W Dankbaar; Henri P Bienfait; Coen van den Berg; Edwin Bennink; Alexander D Horsch; Tom van Seeters; Irene C van der Schaaf; L Jaap Kappelle; Birgitta K Velthuis Journal: Cerebrovasc Dis Date: 2018-05-17 Impact factor: 2.762