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

Abstract

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.

CT Imaging Characteristics and Influence Factors of Renal Dialysis-Associated Peritoneal Injury

“…End-stage renal disease (ESRD) is the end-stage of chronic kidney disease (CKD), characterized by high incidence, critical illness, high medical costs, poor prognosis, and high socioeconomic burden [1][2][3][4][5], and has become an important public health problem worldwide. e prevalence of CKD is 14.8% in the United States and 10.8% in China [6].…”

Thrombolytic therapy for wake‐up stroke: A systematic review and meta‐analysis

“…WUS is different from stroke in the late window because it is possible that the affected patient falls within the 4.5 h for IV tPA. Importantly, imaging characteristics of patients with WUS are more similar to patients known to be within 4.5 h of onset than they are to patients known to be within 4.5 to 9 h of onset [42]. Patients presenting in the 4.5‐ to 9‐h window (stroke in the delayed window) are a distinct subgroup whose treatment with tPA was addressed in the EXTEND (Extending the Time for Thrombolysis in Emergency Neurological Deficits) trial [43].…”

Wake-Up Stroke: relato de caso, importância e perspectivas futuras / Wake-Up Stroke: case report, importance and future perspectives

“…Estudos observacionais que compararam pacientes com WUS e que apresentaram início conhecido não mostraram diferenças significativas quanto às características demográficas (gênero, idade e fatores de risco) dos dois grupos (11)(12)(13)(14) .…”