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Alberta Stroke Program Early CT Score (ASPECTS) in patients with wake-up stroke
Branko N Huisa1, Rema Raman, Karin Ernstrom
1Department of Neurosciences, University of California San Diego, San Diego, California 92103-8466, USA. bhuisagarate@ucsd.edu
Summary
Wake-up strokes, occurring during sleep, show similar early CT scan changes as known-onset strokes. This finding suggests some patients with strokes discovered upon waking may be eligible for thrombolytic therapy.
Area of Science:
- Neurology
- Radiology
- Emergency Medicine
Background:
- Approximately 25% of ischemic strokes occur during sleep.
- Patients with unknown stroke onset times are typically excluded from thrombolytic therapy.
- Early ischemic changes on CT scans may be similar between wake-up strokes and those with known onset.
Purpose of the Study:
- To compare early ischemic changes using the Alberta Stroke Program Early CT Score (ASPECTS) between patients with wake-up ischemic strokes and a control group with known stroke onset times.
- To evaluate the potential eligibility of wake-up stroke patients for thrombolytic therapy based on initial CT findings.
Main Methods:
- Retrospective analysis of a prospectively collected acute stroke database.
- Inclusion criteria for the 'awoke' group: ischemic stroke, last seen normal >4 hours prior, arrival 4-10 a.m., CT scan within 15 hours of last known normal.
- Control group: ischemic stroke, CT scan within 4 hours of known onset. ASPECTS performed by blinded investigators.
Main Results:
- Baseline demographics and risk factors were similar between the awoke and control groups.
- No significant difference in dichotomized ASPECTS (≤7 vs 8-10) between groups (89.3% vs 95.6% ASPECTS 8-10, P=.353).
- A trend towards better 90-day functional outcomes (mRS 0-1) was observed in the awoke group (73% vs 45%, P=.079).
Conclusions:
- Initial ASPECTS scores are comparable in wake-up stroke patients and those with known onset within 4 hours.
- Early CT findings do not significantly differ, suggesting wake-up stroke patients may be candidates for thrombolytic treatment.
- Further research is warranted to confirm suitability for thrombolysis in selected wake-up stroke patients.
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