Wake-Up Stroke: Clinical Characteristics, Imaging Findings, and Treatment Option – an Update
Open Access
- 26 March 2014
- journal article
- review article
- Published by Frontiers Media SA in Frontiers in Neurology
- Vol. 5, 35
- https://doi.org/10.3389/fneur.2014.00035
Abstract
About 25% of all strokes occur during sleep, i.e. without knowledge of exact time of symptom onset. According to licensing criteria, this large group of patients is excluded from treatment with rt-PA, the only specific stroke treatment proven effective in large randomized trials. This paper reviews clinical and imaging characteristics of wake-up stroke and gives an update on treatment options for these patients. From clinical and imaging studies there is evidence suggesting that many wake-up strokes occur close to awakening and thus patients might be within the approved time-window of thrombolysis when presenting to the emergency department. Several imaging approaches are suggested to identify wake-up stroke patients likely to benefit from thrombolysis, including non-contrast CT, CT perfusion, penumbral MRI, and the recent concept of DWI-FLAIR. A number of small case series and observational studies reports results of thrombolysis in wake-up stroke, and no safety concerns have occurred, while conclusions on efficacy cannot be drawn from these studies. To this end, there are ongoing clinical trials enrolling wake-up stroke patients based on imaging findings, i.e. the DWI-FLAIR mismatch (WAKE-UP) or penumbral imaging (EXTEND). The results of these trials will provide evidence to guide thrombolysis in wake-up stroke and thus expand treatment options for this large group of stroke patients.Keywords
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