Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. giselesampaio @ hotmail.com
Cerebrovasc Dis. 2010;29(4):336-42. doi: 10.1159/000278929. Epub 2010 Jan 30.
Approximately 25% of ischemic stroke patients awaken with neurological deficits. In these patients, in whom the time from symptom onset is uncertain, brain imaging is a potential strategy to characterize the ischemia duration and the presence of salvageable brain tissue.
We prospectively evaluated consecutive patients with acute ischemic stroke. CT angiography and CT perfusion (CTP) were performed in patients within 24 h of symptom onset. The patients were classified into 'known onset', 'indefinite onset but not on awakening' and 'wake-up stroke' groups.
Of 676 patients evaluated, 420 had known-onset strokes, 131 wake-up strokes and 125 strokes with an indefinite time of symptom onset. Ischemic lesion volumes were higher in patients with indefinite-onset strokes (p = 0.04). The frequencies of CTP mismatch and of large-vessel intracranial occlusions were similar among the groups (p = 0.9 and p = 0.2, respectively).
The considerable prevalence of CTP mismatch and of intracranial artery occlusions in our patients with wake-up strokes suggests that arterial and perfusion imaging might be particularly important in this population. Revised indications for thrombolysis by using imaging-based protocols might offer these patients the prospect of receiving acute stroke treatment even without a clear time of symptom onset.
约 25%的缺血性脑卒中患者在觉醒时伴有神经功能缺损。在这些患者中，由于发病时间不确定，脑影像学检查是一种评估缺血持续时间和是否存在可挽救脑组织的潜在策略。
我们前瞻性评估了连续的急性缺血性脑卒中患者。发病 24 小时内对患者进行 CT 血管造影和 CT 灌注（CTP）检查。将患者分为“已知发病”、“发病时间不确定但不是在觉醒时”和“觉醒型卒中”组。
在 676 例评估患者中，420 例为已知发病脑卒中，131 例为觉醒型卒中，125 例为发病时间不确定的脑卒中。发病时间不确定的脑卒中患者的缺血性病灶体积较大（p = 0.04）。三组患者 CTP 不匹配和颅内大血管闭塞的频率相似（p = 0.9 和 p = 0.2）。
我们的觉醒型卒中患者 CTP 不匹配和颅内动脉闭塞的比例较高，这表明动脉成像和灌注成像可能对该人群尤为重要。采用基于影像学的溶栓治疗方案修订溶栓适应证，可能使这些患者即使没有明确的发病时间，也有机会接受急性脑卒中治疗。
