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Stroke on awakening: looking for a more rational management
Joaquín Serena1, Antoni Dávalos, Tomás Segura
1Department of Neurology, Hospital Universitari Doctor Josep Trueta, Girona, Spain. jserenal@meditex.es
Cerebrovascular Diseases (Basel, Switzerland)
|June 7, 2003
Summary
Stroke on awakening (SOA) patients show similar characteristics to stroke while awake (SWA) patients. Advanced imaging may help identify nearly half of SOA patients who could benefit from early treatment.
Area of Science:
- Neurology
- Cerebrovascular Diseases
- Clinical Trials
Background:
- Stroke on awakening (SOA) is often excluded from acute stroke trials due to unknown onset time.
- This exclusion denies SOA patients potential benefits of thrombolytic therapy.
Purpose of the Study:
- To compare clinical characteristics of SOA and stroke while awake (SWA).
- To identify potential therapeutic benefits for SOA patients within a 6-hour window.
Main Methods:
- Consecutive inclusion of 1,248 acute cerebral infarction patients in the Stroke Data Bank (BADISEN).
- Analysis of vascular risk factors, neurological findings, stroke severity, diagnosis, and neuroimaging data.
- Comparison between SOA and SWA groups, including a subgroup seen within 6 hours of symptom recognition.
Main Results:
- No significant differences in age, sex, risk factors, severity, or subtypes between SOA and SWA.
- Among patients seen within 6 hours, initial CT scans were normal in 39.4% of SOA cases.
- Advanced imaging (CT/MRI) revealed territorial infarction in 46.2% of early-seen SOA patients, suggesting potential for treatment.
Conclusions:
- Clinical, neuroimaging, and etiological profiles of SOA and SWA are comparable.
- New techniques like DWI/PWI are crucial for identifying early SOA patients who may benefit from acute stroke interventions.