Background
Wake-up stroke (WUS) represents 25% of all ischemic strokes. There is conflicting
evidence concerning clinical severity, imaging characteristics, and outcome when WUS
is compared with stroke of known time of onset. Our aim was to compare WUS patients
with patients with ischemic stroke within the therapeutic window (STW) for thrombolysis.
Methods
This is a retrospective hospital-based study of all consecutive patients hospitalized
for acute ischemic stroke during 2013. Patients with STW, WUS, and WUS with computed
tomography (CT) at 3 hours or less after awakening (WUS≤3h) were selected for the
study. The methods used include a review of clinical records, an independent quantification
of early signs of ischemia on admission CT scan, and determination of functional outcome
on follow-up.
Results
Of 554 patients evaluated, 190 had STW, 113 had WUS (20.4%), and 25 had WUS≤3h. Among
all WUS patients, 33.6% did not have any other formal contraindication for thrombolysis
besides undetermined time of onset. WUS patients had demographic characteristics,
vascular risk factors, and clinical severity similar to STW patients. Mild or absent
early signs of ischemia on admission CT in WUS≤3h patients were similar to those in
STW patients when adjusted for clinical severity (odds ratio [OR] = .50, 95% confidence
interval [CI]=.17-1.47). Favorable prognosis in WUS≤3h was similar to STW when adjusted
for age, clinical severity, and thrombolysis (OR = .53, 95% CI=.09-3.14).
Conclusions
This study strengthens the evidence that clinical and early imaging characteristics
of WUS patients are similar to those of patients with stroke who are eligible for
thrombolysis based on the time window criteria, and patients with WUS do not have
a worse short outcome.
Key Words
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Article info
Publication history
Published online: November 27, 2015
Accepted:
October 31,
2015
Received in revised form:
September 25,
2015
Received:
March 21,
2015
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.10.032
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
