WUSED Study: Wake-Up Strokes in the Emergency Department

Wake-up stroke (WS) poses a unique challenge to the emergency department (ED) physicians and neurologists in terms of planning optimal therapy, as the time of onset of the episode is unknown.

The aim of our study was to profile the WS presenting to the ED and compare the predictors of hemorrhagic versus ischemic types of stroke.

This retrospective study was done in the ED of a large tertiary care hospital in South India from January 2017 to June 2017. The hospital electronic database was accessed for information on patients with WS.

During the study period, a total of 346 patients presented with a stroke, of which 88 (25.4%) patients had a WS. The mean (SD) age was 59 (13) years, three-fourths (73.9%) were males. Only 68% presented to the ED before noon (12 pm). A tenth (10.2%) had a previous stroke. Examination findings included motor deficit (79.5%), slurring of speech (46%). Magnetic resonance imaging (MRI) was done in 33 patients, and computed tomography (CT) was done in 52 patients. The majority (92%) were anterior circulation strokes, with ischemic strokes (82%) being the commonest. Patients with hemorrhagic strokes had a significantly lower mean age (54.31 vs 60.12 years), a higher mean systolic blood pressure (162.50 vs 143.66 mm Hg), and a higher incidence of hypoxia at ED arrival (18.8% versus 4.1%; P = 0.049).