Document Detail

Wake-up stroke: clinical and neuroimaging characteristics.
MedLine Citation:
PMID:  20130399     Owner:  NLM     Status:  MEDLINE    
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.
Gisele S Silva; Fabricio O Lima; Erica C S Camargo; Wade S Smith; Aneesh B Singhal; David M Greer; Hakan Ay; Michael H Lev; Gordon J Harris; Elkan F Halpern; Shruti Sonni; Walter Koroshetz; Karen L Furie
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural     Date:  2010-01-30
Journal Detail:
Title:  Cerebrovascular diseases (Basel, Switzerland)     Volume:  29     ISSN:  1421-9786     ISO Abbreviation:  Cerebrovasc. Dis.     Publication Date:  2010  
Date Detail:
Created Date:  2010-03-12     Completed Date:  2010-06-01     Revised Date:  2011-07-25    
Medline Journal Info:
Nlm Unique ID:  9100851     Medline TA:  Cerebrovasc Dis     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  336-42     Citation Subset:  IM    
Copyright Information:
(c) 2010 S. Karger AG, Basel.
Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. giselesampaio @
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MeSH Terms
Aged, 80 and over
Brain Damage, Chronic / epidemiology,  etiology
Brain Ischemia / pathology,  radiography*
Cerebral Angiography
Cohort Studies
Fibrinolytic Agents / administration & dosage
Hospitals, University / statistics & numerical data
Image Processing, Computer-Assisted*
Middle Aged
Perfusion Imaging
Prospective Studies
Severity of Illness Index
Single-Blind Method
Thrombolytic Therapy* / contraindications
Time Factors
Tomography, X-Ray Computed / methods*
Grant Support
Reg. No./Substance:
0/Fibrinolytic Agents

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