Katharina Vedder1, Dr Anne Ebert2, Prof Dr Kristina Szabo3, Prof Dr Alex Förster4, Prof Dr Angelika Alonso5. 1. Department of Neurology, Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. Electronic address: katha004@googlemail.com. 2. Department of Neurology, Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. Electronic address: anne.ebert@umm.de. 3. Department of Neurology, Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. Electronic address: kristina.szabo@umm.de. 4. Department of Neuroradiology, Medical Faculty Mannheim, University of Heidelberg, Germany. Electronic address: alex.forster@umm.de. 5. Department of Neurology, Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. Electronic address: angelika.alonso@um.de.
Abstract
OBJECTIVES: Patients with unknown onset stroke (UOS) can be categorized as wake-up stroke (WUS) and daytime-unwitnessed stroke (DUS). We sought to determine whether decisions for initial imaging modalities, frequency of mismatch findings, resulting treatment decisions and outcome differ between WUS and DUS patients. MATERIALS AND METHODS: In a retrospective analysis, all patients with UOS admitted to our Stroke Unit from January to December 2018 were evaluated and classified as either WUS or DUS. RESULTS: 180 patients were included (74.4 % WUS, 25.6 % DUS). Compared to WUS patients, DUS patients received more often a non-contrast computed tomography initially (43.5 % vs. 24.6 %, p = 0.016). MR imaging was performed more frequently in WUS patients (53.7 % vs. 34.8 %, p = 0.027). The rate of mismatch findings in patients examined with either multimodal CT or MRI (126 patients, 101 WUS and 26 DUS) did not differ between the groups. Likewise, the rate of intravenous thrombolysis or mechanical thrombectomy was similar in both groups. DUS patients had more often severe neurological deficits at admission as defined by the National Institutes of Stroke Scale score (14.2 vs. 8.6, p < 0.001). CONCLUSIONS: Patients with DUS had disadvantages in mismatch-based treatment options due to initial imaging modalities. Current data do not support different treatment concepts in WUS and DUS patients. All UOS patients should initially be evaluated by either multimodal CT or MRI to open a chance to receive reperfusion therapy.
OBJECTIVES:Patients with unknown onset stroke (UOS) can be categorized as wake-up stroke (WUS) and daytime-unwitnessed stroke (DUS). We sought to determine whether decisions for initial imaging modalities, frequency of mismatch findings, resulting treatment decisions and outcome differ between WUS and DUSpatients. MATERIALS AND METHODS: In a retrospective analysis, all patients with UOS admitted to our Stroke Unit from January to December 2018 were evaluated and classified as either WUS or DUS. RESULTS: 180 patients were included (74.4 % WUS, 25.6 % DUS). Compared to WUS patients, DUSpatients received more often a non-contrast computed tomography initially (43.5 % vs. 24.6 %, p = 0.016). MR imaging was performed more frequently in WUS patients (53.7 % vs. 34.8 %, p = 0.027). The rate of mismatch findings in patients examined with either multimodal CT or MRI (126 patients, 101 WUS and 26 DUS) did not differ between the groups. Likewise, the rate of intravenous thrombolysis or mechanical thrombectomy was similar in both groups. DUSpatients had more often severe neurological deficits at admission as defined by the National Institutes of Stroke Scale score (14.2 vs. 8.6, p < 0.001). CONCLUSIONS:Patients with DUS had disadvantages in mismatch-based treatment options due to initial imaging modalities. Current data do not support different treatment concepts in WUS and DUSpatients. All UOS patients should initially be evaluated by either multimodal CT or MRI to open a chance to receive reperfusion therapy.