Implementation of emergent MRI for wake-up stroke: a single-center experience

Area of Science:

• Neurology
• Radiology
• Stroke Medicine

Background:

• National guidelines now include emergent MRI for wake-up strokes.
• Wake-up strokes present diagnostic challenges due to unknown symptom onset times.
• A DWI-FLAIR mismatch is a key concept for interpreting emergent MRIs in these cases.

Purpose of the Study:

• To analyze the implementation of a new workflow using emergent MRI for wake-up strokes.
• To describe the DWI-FLAIR mismatch concept in the context of emergent MRI for wake-up strokes.
• To evaluate the effectiveness of emergent MRI in a Comprehensive Stroke Center setting.

Main Methods:

• Retrospective case series of 16 patients with wake-up strokes over 14 months.
• Analysis of brain MRIs by two fellowship-trained neuroradiologists.
• Assessment of process metrics including time intervals and DWI-FLAIR mismatch diagnosis.

Main Results:

• 13 out of 16 patients (81.3%) showed a DWI-FLAIR mismatch, indicating infarct < 4.5 hours old.
• Mean time from last known well to MRI was 7.89 hours.
• 46% of patients with DWI-FLAIR mismatch received intravenous thrombolysis.

Conclusions:

• Successful implementation of emergent MRI for wake-up strokes depends on accurate MRI interpretation and stakeholder collaboration.
• 24/7 availability of MRI and onsite neurology/radiology coverage are crucial.
• This workflow facilitates timely diagnosis and treatment for wake-up stroke patients.