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Klobučníková K, Kollár B, Jurík M, Valovičová K, Hardoňová M, Poddaný M, Tedla M, Riant M, Klail P, Turčáni P, Šiarnik P. No Difference in Sleep Desaturations Severity between Patients with Wake-Up and Non-Wake-Up Stroke: A PRESS Study Results. Life (Basel) 2023; 13:life13020517. [PMID: 36836872 PMCID: PMC9959436 DOI: 10.3390/life13020517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/08/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Wake-up stroke (WUS) is a certain type of ischemic stroke in which a patient wakes up with a new neurological deficit due to cerebral ischemia. Sleep-disordered breathing is an independent risk factor for stroke, but the role of nocturnal oxygen desaturation in the pathophysiology of WUS is still insufficiently explored. According to several studies, patients with WUS have a significantly more severe sleep apnea syndrome and lower mean blood oxygen saturation. This study aimed to assess the severity of nocturnal desaturations in acute WUS and non-WUS patients using nocturnal pulse oximetry. MATERIAL AND METHODS The cohort of 225 consecutive patients with neuroimaging-verified acute cerebral ischemia was prospectively enrolled. For further analyses, 213 subjects with known WUS/non-WUS status were selected (111 males and 102 females, average age 70.4 ±12.9, median baseline NIHSS = 5, median baseline mRS = 3). Patients were divided into the WUS group (n = 45) and the non-WUS group (n = 168). Overnight pulse oximetry was performed within 7 days of the stroke onset and data of both of the studied groups were compared. RESULTS We found oxygen desaturation index (ODI) in the WUS group was 14.5 vs. 16.6 (p = 0.728) in the non-WUS group, basal O2 saturation was 92.2% vs. 92.5% (p = 0.475), average low O2 saturation was 90.3% vs. 89.6% (p = 0.375), minimal O2 saturation was 79.5% vs. 80.6% (p = 0.563), and time with O2 saturation <90% (T90) was 4.4% vs. 4.7% (p = 0.729). CONCLUSIONS In the studied sample, monitored respiratory parameters including ODI, basal O2 saturation, average low O2 saturation, minimal O2 saturation, and T90 did not significantly differ between groups of WUS and non-WUS patients.
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Affiliation(s)
- Katarína Klobučníková
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 814 69 Bratislava, Slovakia
| | - Branislav Kollár
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 814 69 Bratislava, Slovakia
- Correspondence: ; Tel.: +421-2572-90147
| | - Matúš Jurík
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 814 69 Bratislava, Slovakia
| | - Katarína Valovičová
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 814 69 Bratislava, Slovakia
| | - Miroslava Hardoňová
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 814 69 Bratislava, Slovakia
| | - Michal Poddaný
- Department of Neurology, General Hospital, 031 23 Liptovsky Mikulas, Slovakia
| | - Miroslav Tedla
- Department of ENT and HNS, Faculty of Medicine, University Hospital Bratislava, Comenius University, 814 69 Bratislava, Slovakia
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2T8, UK
| | - Michal Riant
- Department of Otorhinolaryngology, University Hospital, Faculty of Medicine in Pilsen, Charles University, 100 00 Prague, Czech Republic
| | - Pavel Klail
- Department of Otorhinolaryngology, University Hospital, Faculty of Medicine in Pilsen, Charles University, 100 00 Prague, Czech Republic
| | - Peter Turčáni
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 814 69 Bratislava, Slovakia
| | - Pavel Šiarnik
- 1st Department of Neurology, Faculty of Medicine, Comenius University, 814 69 Bratislava, Slovakia
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Wang Y, Xin Y, Wang XX, Zhang YL, Zhang Y, Wang Y, Peng L, Wu YC. Ambient fine particulate pollution hysteresis triggers wake-up stroke and rapidly triggers non-wake-up stroke: a case-crossover study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:82243-82255. [PMID: 35748992 DOI: 10.1007/s11356-022-21458-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
Atmospheric pollutants increase the risk of acute ischemic stroke (AIS) which has been widely reported. However, little is known about the relationships between air pollution and specific subsets of AIS, such as wake-up stroke (WUS) and non-wake-up stroke (non-WUS). This study aimed to explore the relationship between WUS and non-WUS and atmospheric pollutants. A total of 1432 patients (331 WUS patients and 1101 non-WUS patients) were admitted to a tertiary hospital from 2016 to 2019. A time-stratified case-crossover design and a conditional logistic regression model to study the associations of change in pollutant concentration with WUS and non-WUS events were constructed. Data analysis revealed that WUS-related risks increased 48 to 72 h after the increase in the PM2.5 concentration (each 10 μg/m3 increase, lag 0-72 h) [threshold OR (95% CI):18 μg/m3 1.03 (0.94-1.11), 35 μg/m3 1.01 (0.92-1.12), 50 μg/m3 1.04 (0.91-1.19)]; the non-WUS-related risk increased 1 to 6 h after the increase in the PM2.5 concentration (each 10 μg/m3 increase, lag 0-1 h) [threshold OR (95% CI):18 μg/m3 1.01 (0.98-1.03), 35 μg/m3 1.00 (0.97-1.04), 50 μg/m3 1.01 (0.96-1.05)] (lag 0-6 h) [threshold OR (95% CI): 18 μg/m3 1.00 (0.97-1.03), 35 μg/m3 1.00 (0.97-1.04), 50 μg/m3 1.01 (0.97-1.06)]; O3 exposure was related to WUS events, and its impact on WUS events was stronger and longer-lasting (1-96 h) than its impact on non-WUS events (1-6 h). Greater than or equal to 65 years of age, overweight (BMI ≥ 25), and diabetes had a significantly greater risk of WUS associated with increased PM2.5 concentration in the previous 12-96 h than patients without these conditions. Patients with hypertension and smoking had a significant risk of non-WUS associated with increased PM2.5 concentration in the previous 1-6 h. The increase in PM2.5 concentration in the cold season increased the risk of both WUS and non-WUS events. Ambient air pollution hysteresis triggers WUS and rapidly triggers non-WUS, even if the degree of pollutant is relatively low. Patients with elderly, overweight, and diabetes appeared particularly susceptible to WUS, and patients with hypertension and smoking history were susceptible to non-WUS. We need to expand the sample for further investigation into mechanisms by which environmental pollutants trigger WUS or non-WUS.
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Affiliation(s)
- Yan Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 86 Wujin Road, Shanghai, 200080, People's Republic of China
| | - Yuan Xin
- Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240, People's Republic of China
| | - Xi-Xi Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 86 Wujin Road, Shanghai, 200080, People's Republic of China
| | - Yu-Lei Zhang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 86 Wujin Road, Shanghai, 200080, People's Republic of China
- The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Yue Zhang
- Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240, People's Republic of China
| | - Yu Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 86 Wujin Road, Shanghai, 200080, People's Republic of China
| | - Li Peng
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, 200135, People's Republic of China
| | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 86 Wujin Road, Shanghai, 200080, People's Republic of China.
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Abstract
SUMMARY Ischemic strokes most often occur between 6 am and 12 am after awakening from sleep but up to 30% occur during sleep. Wake-up strokes (WUS) are new focal neurological deficit(s) persisting for ≥ 24 hours attributable to an ischemic event present on patient awakening. Obstructive sleep apnea (OSA) is a major risk factor for WUS because it compounds the instability of the morning environment and increases the likelihood of cardiovascular events, including hypertension, atrial fibrillation, right-to-left shunts, and stroke. Circadian-driven alterations in structural, homeostatic, and serological factors also predispose to WUS. Also, WUS patients are often not considered candidates for time-dependent intravenous thrombolysis therapy because of an uncertain onset time. However, using the tissue clock (positive diffusion weighted imaging-negative fluid-attenuated inversion recovery mismatch) dates the WUS as 3 to 4.5 hours old and permits consideration for intravenous thrombolysis and if needed mechanical thrombectomy. Given the high prevalence of moderate/severe OSA in stroke patients and its impact on stroke outcomes, screening with overnight pulse oximetry and home sleep apnea test is needed. Treating OSA poststroke remains challenging. Polysomnographic changes in sleep architecture following acute/subacute stroke may also impact upon stroke outcome.
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Affiliation(s)
- Atif Zafar
- Department of Neurology, University of Toronto, Toronto, ON, Canada
| | - Parth Dhruv
- Department of Neurology, Kaiser Permanente, Santa Clara, California, U.S.A
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Zhong C, Yin C, Niu G, Ning L, Pan J. MicroRNA miR-497 is closely associated with poor prognosis in patients with cerebral ischemic stroke. Bioengineered 2021; 12:2851-2862. [PMID: 34152256 PMCID: PMC8806653 DOI: 10.1080/21655979.2021.1940073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Cerebral ischemic stroke (CIS) is the most common type of stroke, which is highly hazardous. This investigation aims to analyze the correlation of miR-497 with CIS, so as to provide reliable evidence for clinical response to CIS and lay a solid foundation for follow-up research. Eighty-nine CIS patients and 39 concurrent physical examinees selected between June 2017 and October 2018 were enrolled as the research participants. Additionally, SD rats with increased miR-497 expression and normal SD rats were purchased for CIS modeling to observe the clinical implications of miR-497 in CIS, as well as the water content of brain tissue and neuronal apoptosis of rats. miR-497 expression was lower in CIS patients than in physical examinees, and that in patients with complete stroke (CS) was the lowest, which increased after treatment. As determined by the receiver operating characteristic curve (ROC) analysis, miR-497 had an outstanding diagnostic efficacy for CIS and was negatively correlated with the National Institutes of Health Stroke Scale (NIHSS) and MDA concentration, while positively related to SOD concentration. Prognostic follow-up demonstrated that decreased miR-497 expression in patients after treatment predicted an increased risk of prognostic death and recurrence. However, observed in rats, the water content of the brain tissue of rats with increased miR-497 expression was reduced, and the neuronal apoptosis rate of the brain tissue was inhibited. Taken together, with low expression in CIS, miR-497 is strongly related to CIS progression and is a candidate CIS marker.
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Affiliation(s)
- Changyang Zhong
- Department of Neurology, Hangzhou Third People's Hospital, Hangzhou, Zhejiang, China
| | - Congguo Yin
- Department of Neurology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China
| | - Guozhong Niu
- Department of Neurology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China
| | - Li Ning
- Nursing Department, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China
| | - Jinbo Pan
- Department of ICU, Hangzhou Third People's Hospital, Hangzhou, Zhejiang, China
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Le SM, Copeland LA, Zeber JE, Benge JF, Allen L, Cho J, Liao IC, Rasmussen J. Factors affecting time between symptom onset and emergency department arrival in stroke patients. eNeurologicalSci 2020; 21:100285. [PMID: 33204859 PMCID: PMC7649365 DOI: 10.1016/j.ensci.2020.100285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/21/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background and purpose Delays in seeking care compromise diagnosis, treatment options, and outcomes in ischemic strokes. This study identified factors associated with time between stroke symptom onset and emergency department (ED) arrival at a private nonprofit medical center serving a large rural catchment area in central Texas, with the goal of identifying symptomatic, demographic, and historical factors that might influence seeking care. Methods Demographic and clinical data from a large tertiary care center's Get With The Guidelines (GWTG) database were evaluated in 1874 patients presenting to the ED with a diagnosis of transient ischemic attack (TIA), intracranial hemorrhage, subarachnoid hemorrhage, or ischemic stroke. The dependent variable was time between discovery of stroke symptoms and presentation at the hospital (time-to-ED). Factors entered into regression models predicting time-to-ED within 4 h or categorical time-to-ED. Results The average time from symptom onset to presentation was 15.0 h (sd = 23.2), with 43.6% of the sample presenting within 4 h of symptom onset. Results suggested that female gender (Odds Ratio [OR] = 0.70; 95% Confidence Interval [CI] 0.23–0.74), drug abuse (OR = 0.41; CI 0.23–0.74), and diabetes were significantly associated with longer time to presentation. Conclusions A combination of demographics, stroke severity, timing, and health history contributes to delays in presenting for treatment for ischemic stroke. Stroke education concentrating on symptom recognition may benefit from a special focus on high-risk individuals as highlighted in this study. Patients that had stroke symptoms occurring during the daytime were more likely to present within 4h of symptom onset. Females and younger patients were more likely to arrive after 4h of symptom onset. Comorbid conditions such as diabetes and substance abuse were associated with delayed presentation times. Other comorbid conditions such as hypertension or dyslipidemia were not associated with decreased time of presentation.
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Affiliation(s)
- Scott M Le
- Duke Health, Department of Neurology, Division of Vascular Neurology and Stroke, 40 Duke Medicine, Circle, Durham, NC 27710, United States of America.,Baylor Scott & White Health, Department of Neurology, 2401 S 31 Street, Temple, TX 76508, United States of America.,Texas A&M Health Science Center College of Medicine, 8447 Bryan Rd, Bryan, TX 77807, United States of America
| | - Laurel A Copeland
- VA Central Western Massachusetts, 421 N Main St, Leeds, MA 01053, United States of America.,University of Massachusetts Medical School, Department of Population and Quantitative Health Sciences, 55 N Lake Ave, Worcester, MA 01655, United States of America
| | - John E Zeber
- University of Massachusetts at Amherst, School of Public Health & Health Sciences, Health Policy & Management, 300 Massachusetts Ave, Amherst, MA 01003, United States of America
| | - Jared F Benge
- Baylor Scott & White Health, Department of Neurology, 2401 S 31 Street, Temple, TX 76508, United States of America.,Texas A&M Health Science Center College of Medicine, 8447 Bryan Rd, Bryan, TX 77807, United States of America
| | - Leigh Allen
- Baylor Scott & White Health, Department of Neurology, 2401 S 31 Street, Temple, TX 76508, United States of America.,Ascension Seton, 1201 West 38 St, Austin, TX 78705, United States of America
| | - Jinmyoung Cho
- Baylor Scott & White Health, Center for Applied Health Research, 4236 Lowes Dr., Temple, TX 76502, United States of America
| | - I-Chia Liao
- Baylor Scott & White Health, Center for Applied Health Research, 4236 Lowes Dr., Temple, TX 76502, United States of America
| | - Jennifer Rasmussen
- Baylor Scott & White Health, Department of Neurology, 2401 S 31 Street, Temple, TX 76508, United States of America.,Texas A&M Health Science Center College of Medicine, 8447 Bryan Rd, Bryan, TX 77807, United States of America
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Abstract
Wake-up stroke (WUS) or ischemic stroke occurring during sleep accounts for 14%-29.6% of all ischemic strokes. Management of WUS is complicated by its narrow therapeutic time window and attributable risk factors, which can affect the safety and efficacy of administering intravenous (IV) tissue plasminogen activator (t-PA). This manuscript will review risk factors of WUS, with a focus on obstructive sleep apnea, potential mechanisms of WUS, and evaluate studies assessing safety and efficacy of IV t-PA treatment in WUS patients guided by neuroimaging to estimate time of symptom onset. The authors used PubMed (1966 to March 2018) to search for the term "Wake-Up Stroke" cross-referenced with "pathophysiology," ''pathogenesis," "pathology," "magnetic resonance imaging," "obstructive sleep apnea," or "treatment." English language Papers were reviewed. Also reviewed were pertinent papers from the reference list of the above-matched manuscripts. Studies that focused only on acute Strokes with known-onset of symptoms were not reviewed. Literature showed several potential risk factors associated with increased risk of WUS. Although the onset of WUS is unknown, a few studies investigated the potential benefit of magnetic resonance imaging (MRI) in estimating the age of onset which encouraged conducting clinical trials assessing the efficacy of MRI-guided thrombolytic therapy in WUS.
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Zhang YL, Zhang JF, Wang XX, Wang Y, Anderson CS, Wu YC. Wake-up stroke: imaging-based diagnosis and recanalization therapy. J Neurol 2020; 268:4002-4012. [PMID: 32671526 DOI: 10.1007/s00415-020-10055-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 02/08/2023]
Abstract
Wake-up stroke (WUS) is a subgroup of ischemic stroke in which patients show no abnormality before sleep while wake up with neurological deficits. In addition to the uncertain onset, WUS patients have difficulty to receive prompt and effective thrombolytic or reperfusion therapy, leading to relatively poor prognosis. A number of researches have indicated that CT or MRI based thrombolysis and endovascular therapy might have benefits for WUS patients. This review article narratively discusses the pathogenesis, risk factors, imaging-based diagnosis and recanalization treatments of WUS with the purpose of expanding current treatment options for this group of stroke patients and exploring better therapeutic methods. The result showed that multimodal MRI or CT scan might be the best methods for extending the time window of WUS and, therefore, a large proportion of WUS patients could have favorable prognosis.
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Affiliation(s)
- Yu-Lei Zhang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People's Republic of China
| | - Jun-Fang Zhang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People's Republic of China
| | - Xi-Xi Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People's Republic of China
| | - Yan Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People's Republic of China
| | | | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People's Republic of China.
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Wake-up stroke: thrombolysis reduces ischemic lesion volume and neurological deficit. J Neurol 2019; 267:666-673. [PMID: 31720820 DOI: 10.1007/s00415-019-09603-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUNDS Wake-Up Stroke (WUS) patients are generally excluded from thrombolytic therapy (rTPA) due to the unknown time of stroke onset. This study aimed to investigate the effects of rTPA in WUS patients during every day clinical scenarios, by measuring ischemic lesion volume and functional outcomes compared to non-treated WUS patients. METHODS We retrospectively analyzed clinical and imaging data of 149 (75 rTPA; 74 non-rTPA) patients with acute ischemic WUS. Ischemic volume was calculated on follow-up CT and functional outcomes were the NIHSS and mRS comparing rTPA and non-rTPA WUS. Patients were selected using ASPECTS > 6 on CT and/or ischemic penumbra > 50% of hypoperfused tissue on CTP. RESULTS A reduced volume was measured on the follow-up CT for rTPA (1 mL, 0-8) compared to the non-rTPA patients (10 mL, 0-40; p = 0.000). NIHSS at 7 days from admission was significantly lower in the rTPA (1, 0-4) compared to non-rTPA group (3, 1-9; p = 0.015), as was the percentage of improvement (ΔNIHSS) (70% vs 50%; p = 0.002). A higher prevalence of mRS 0-2 was observed in the rTPA compared to the non-rTPA (54% vs 39%; p = 0.060). Multivariate analysis showed that NIHSS at baseline and rTPA treatment are significant predictors of good outcome both in terms of NIHSS at 7 days and ischemic lesion volume on follow-up CT (p < 0.05). CONCLUSIONS rTPA in WUS patients selected with CT and/or CTP resulted in reduced ischemic infarct volume on follow-up CT and better functional outcome without increment of intracranial hemorrhages and in-hospital mortality.
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How should we treat patients who wake up with a stroke? A review of recent advances in management of acute ischemic stroke. Am J Emerg Med 2019; 37:954-959. [PMID: 30824272 DOI: 10.1016/j.ajem.2019.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/09/2019] [Indexed: 12/22/2022] Open
Abstract
Acute ischemic strokes account for 85% of all strokes and are the fifth leading cause of mortality in the United States. About one in five of all ischemic strokes occur during sleep and are not noticed until the patient wakes up with neurological deficits. There is growing evidence to support that a significantly higher number of stroke patients could benefit from more aggressive care, especially those patients who wake up with strokes. There is increasing research to support a physiologically-based approach based on advanced imaging rather than simply a time-based determination of whether or not a patient would benefit from reperfusion. Advanced imaging such as CT-Perfusion and MR DWI-FLAIR can be used to establish the age of the lesion and determine the extent of the brain tissue that is salvageable. If physicians could identify those patients with wake-up strokes that are candidates for intervention, there may be opportunity to treat 3 million more people, reducing long term disability and healthcare expenditures. Patients who are in the window for IV rtPA should receive it as soon as possible as well as be evaluated for mechanical thrombectomy. For those who are out of the window for IV rtPA, consider further imaging such as CTP and MR brain for diffusion-weighted sequences to evaluate for potential endovascular intervention. If a large vessel occlusion is present and imaging demonstrates a small infarct core and a large area of salvageable tissue, mechanical thrombectomy may be beneficial for the best possible functional outcome.
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11
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Sun T, Xu Z, Diao SS, Zhang LL, Fang Q, Cai XY, Kong Y. Safety and cost-effectiveness thrombolysis by diffusion-weighted imaging and fluid attenuated inversion recovery mismatch for wake-up stroke. Clin Neurol Neurosurg 2018; 170:47-52. [PMID: 29729542 DOI: 10.1016/j.clineuro.2018.04.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/13/2018] [Accepted: 04/22/2018] [Indexed: 01/16/2023]
Abstract
Wake-up stroke, defined as patients who wake up with stroke symptoms which were not present prior to falling asleep, accounted for 14%-25% of acute ischemic stroke. Due to the unknown time of symptom onset, wake-up stoke was not in including criteria of intravenous thrombolysis. Several large randomized stroke trials using diffusion-weighted imaging(DWI)and fluid attenuated inversion recovery(FLAIR)mismatch patient selection may identify a subset of patients with wake-up stroke that can safely and effectively benefit from intravenous thrombolysis. In addition, economic factor was another important limitation to generalize thrombolysis treatment. Fortunately, MRI-based thrombolysis was a cost-effective treatment for wake-up stroke compared to these patients with no thrombolysis.
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Affiliation(s)
- Tong Sun
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Zhuan Xu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Shan-Shan Diao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Lu-Lu Zhang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Xiu-Ying Cai
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
| | - Yan Kong
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
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12
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Wake-up stroke and sleep-disordered breathing: a meta-analysis of current studies. J Neurol 2018; 265:1288-1294. [DOI: 10.1007/s00415-018-8810-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 02/22/2018] [Accepted: 02/24/2018] [Indexed: 01/10/2023]
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Escalard S, Gory B, Kyheng M, Desilles JP, Redjem H, Ciccio G, Smajda S, Labreuche J, Mazighi M, Piotin M, Blanc R, Lapergue B, Fahed R. Unknown-onset strokes with anterior circulation occlusion treated by thrombectomy after DWI-FLAIR mismatch selection. Eur J Neurol 2018; 25:732-738. [DOI: 10.1111/ene.13580] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/11/2018] [Indexed: 11/30/2022]
Affiliation(s)
- S. Escalard
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
| | - B. Gory
- Department of Interventional Neuroradiology; Hôpital Neurologique Pierre Wertheimer; Bron France
| | - M. Kyheng
- EA 2694-Santé Publique: Epidémiologie et Qualité des Soins; CHU Lille; University of Lille; Lille France
| | - J.-P. Desilles
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
- Laboratory of Vascular Translational Science; U1148 Institut National de la Santé et de la Recherche Médicale (INSERM); Paris France
| | - H. Redjem
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
| | - G. Ciccio
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
| | - S. Smajda
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
| | - J. Labreuche
- EA 2694-Santé Publique: Epidémiologie et Qualité des Soins; CHU Lille; University of Lille; Lille France
| | - M. Mazighi
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
- Laboratory of Vascular Translational Science; U1148 Institut National de la Santé et de la Recherche Médicale (INSERM); Paris France
- Paris Diderot and Sorbonne Paris Cite Universities; Paris France
- DHU NeuroVasc; Paris France
| | - M. Piotin
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
- Laboratory of Vascular Translational Science; U1148 Institut National de la Santé et de la Recherche Médicale (INSERM); Paris France
| | - R. Blanc
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
- Laboratory of Vascular Translational Science; U1148 Institut National de la Santé et de la Recherche Médicale (INSERM); Paris France
| | - B. Lapergue
- Laboratory of Vascular Translational Science; U1148 Institut National de la Santé et de la Recherche Médicale (INSERM); Paris France
- Department of Neurology; Stroke Center; Foch Hospital; University Versailles Saint-Quentin en Yvelines; Suresnes France
| | - R. Fahed
- Department of Interventional Neuroradiology; Fondation Rothschild; Paris France
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