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- Title
Wake-Up Stroke: Clinical and Neuroimaging Characteristics.
- Authors
Silva, Gisele S.; 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.
- 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 © 2010 S. Karger AG, Basel
- Subjects
CEREBROVASCULAR disease patients; ISCHEMIA; MEDICAL imaging systems; THROMBOLYTIC therapy; BLOOD circulation disorders
- Publication
Cerebrovascular Diseases, 2010, Vol 29, Issue 4, p336
- ISSN
1015-9770
- Publication type
Article
- DOI
10.1159/000278929