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Title: Wake-Up Stroke: Clinical and Neuroimaging Characteristics
Authors: Silva, Gisele Sampaio [UNIFESP]
Lima, Fabricio O.
Camargo, Erica C. S.
Smith, Wade S.
Singhal, Aneesh B.
Greer, David M.
Ay, Hakan
Lev, Michael H.
Harris, Gordon J.
Halpern, Elkan F.
Sonni, Shruti
Koroshetz, Walter
Furie, Karen L.
Massachusetts Gen Hosp
Harvard Univ
Univ Calif San Francisco
Universidade Federal de São Paulo (UNIFESP)
Keywords: Wake-up stroke
Computed tomography angiography
Computed tomography perfusion
Ischemic penumbra
Issue Date: 1-Jan-2010
Publisher: Karger
Citation: Cerebrovascular Diseases. Basel: Karger, v. 29, n. 4, p. 336-342, 2010.
Abstract: Background: Approximately 25% of ischemic stroke patients awaken with neurological deficits. in these patients, in whom the time from symptom onset is uncertain, brain imaging is a potential strategy to characterize the ischemia duration and the presence of salvageable brain tissue. Methods: We prospectively evaluated consecutive patients with acute ischemic stroke. CT angiography and CT perfusion (CTP) were performed in patients within 24 h of symptom onset. the patients were classified into 'known onset', 'indefinite onset but not on awakening' and 'wake-up stroke' groups. Results: of 676 patients evaluated, 420 had known-onset strokes, 131 wake-up strokes and 125 strokes with an indefinite time of symptom onset. Ischemic lesion volumes were higher in patients with indefinite-onset strokes ( p = 0.04). the frequencies of CTP mismatch and of large-vessel intracranial occlusions were similar among the groups ( p = 0.9 and p = 0.2, respectively). Conclusion: the considerable prevalence of CTP mismatch and of intracranial artery occlusions in our patients with wake-up strokes suggests that arterial and perfusion imaging might be particularly important in this population. Revised indications for thrombolysis by using imaging-based protocols might offer these patients the prospect of receiving acute stroke treatment even without a clear time of symptom onset. Copyright (C) 2010 S. Karger AG, Basel
ISSN: 1015-9770
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