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.
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.
Authors: Bruce C V Campbell; Søren Christensen; Christopher R Levi; Patricia M Desmond; Geoffrey A Donnan; Stephen M Davis; Mark W Parsons Journal: Stroke Date: 2011-10-06 Impact factor: 7.914
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: I Y L Tan; A M Demchuk; J Hopyan; L Zhang; D Gladstone; K Wong; M Martin; S P Symons; A J Fox; R I Aviv Journal: AJNR Am J Neuroradiol Date: 2009-01-15 Impact factor: 3.825
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: Volker Puetz; P N Sylaja; Shelagh B Coutts; Michael D Hill; Imanuel Dzialowski; Pia Mueller; Ulf Becker; Gabriele Urban; Christine O'Reilly; Philip A Barber; Pranshu Sharma; Mayank Goyal; Georg Gahn; Ruediger von Kummer; Andrew M Demchuk Journal: Stroke Date: 2008-07-10 Impact factor: 7.914
Authors: Jean-Marc Olivot; Michael Mlynash; Vincent N Thijs; Stephanie Kemp; Maarten G Lansberg; Lawrence Wechsler; Roland Bammer; Michael P Marks; Gregory W Albers Journal: Stroke Date: 2008-12-24 Impact factor: 7.914
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: Patrick D Lyden; Kent E Pryor; Jennifer Minigh; Thomas P Davis; John H Griffin; Howard Levy; Berislav V Zlokovic Journal: Front Neurol Date: 2021-03-15 Impact factor: 4.003
Authors: Tomáš Peisker; Peter Vaško; Petr Mikulenka; David Lauer; Boris Kožnar; Jakub Sulženko; Filip Roháč; Dušan Kučera; David Girsa; Karin Kremeňová; Petr Widimský; Ivana Štětkářová Journal: Eur Heart J Suppl Date: 2022-03-30 Impact factor: 1.624