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Wake-up (or wake-up for) stroke: a treatable stroke
Sandra Bracco1, Rossana Tassi, Paola Gennari
1Unit NINT Neuroimaging and Neurointervention, Department of Neurological and Sensorineural Sciences, Siena Hospital Trust, "Santa Maria alle Scotte Hospital"; Siena, Italy - alfonsocerase@gmail.com - a.cerase@ao-siena.toscana.it.
The Neuroradiology Journal
|November 9, 2013
Summary
This case report details a successful wake-up stroke treatment using neuroendovascular intervention, extending the therapeutic window with CT perfusion. The patient achieved an acceptable outcome, demonstrating the value of advanced imaging in stroke care.
Area of Science:
- Neuroendovascular treatment
- Stroke imaging
- Cerebrovascular disease
Background:
- Wake-up strokes present diagnostic challenges due to unknown symptom onset.
- Standard treatment windows for acute ischemic stroke are often exceeded in wake-up stroke cases.
- CT perfusion imaging aids in assessing ischemic core and penumbra, guiding treatment decisions.
Observation:
- A 74-year-old male presented with acute neurological deficits consistent with stroke upon waking.
- Imaging revealed a right middle cerebral artery (MCA) occlusion and a significant ischemic penumbra despite a 14-hour time last-seen well.
- Neurological status worsened, prompting consideration for neuroendovascular intervention.
Findings:
- Off-label neuroendovascular treatment was performed using the Penumbra system for the right MCA occlusion.
- Partial recanalization was achieved, and the patient was discharged with a moderate NIHSS score.
- At six months, the patient had a modified Rankin Scale score of 3, indicating a favorable outcome.
Implications:
- CT perfusion can help identify suitable candidates for neuroendovascular treatment beyond standard time windows in wake-up strokes.
- This case highlights the potential for successful outcomes in selected wake-up stroke patients with extended treatment protocols.
- Further research into extended therapeutic windows for wake-up strokes guided by perfusion imaging is warranted.
Keywords:
neuroendovascular treatmentneuroimaging-based reperfusion therapythrombolysisunclear onset-strokewake-up strokeMore Related Videos
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