Rimmele D Leander, Thomalla Götz
Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf , Hamburg , Germany.
Front Neurol. 2014 Mar 26;5:35. doi: 10.3389/fneur.2014.00035. eCollection 2014.
About 25% of all strokes occur during sleep, i.e., without knowledge of exact time of symptom onset. According to licensing criteria, this large group of patients is excluded from treatment with received tissue-plasminogen activator, the only specific stroke treatment proven effective in large randomized trials. This paper reviews clinical and imaging characteristics of wake-up stroke and gives an update on treatment options for these patients. From clinical and imaging studies, there is evidence suggesting that many wake-up strokes occur close to awakening and thus, patients might be within the approved time-window of thrombolysis when presenting to the emergency department. Several imaging approaches are suggested to identify wake-up stroke patients likely to benefit from thrombolysis, including non-contrast CT, CT-perfusion, penumbral MRI, and the recent concept of diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR). A number of small case series and observational studies report results of thrombolysis in wake-up stroke, and no safety concerns have occurred, while conclusions on efficacy cannot be drawn from these studies. To this end, there are ongoing clinical trials enrolling wake-up stroke patients based on imaging findings, i.e., the DWI-FLAIR-mismatch (WAKE-UP) or penumbral imaging (EXTEND). The results of these trials will provide evidence to guide thrombolysis in wake-up stroke and thus, expand treatment options for this large group of stroke patients.
约25%的中风发生在睡眠期间，即患者不知道症状确切发作时间。根据许可标准，这一庞大患者群体被排除在接受组织型纤溶酶原激活剂治疗之外，而组织型纤溶酶原激活剂是唯一在大型随机试验中被证明有效的特异性中风治疗药物。本文综述了醒后中风的临床和影像学特征，并介绍了这些患者的最新治疗选择。临床和影像学研究表明，有证据显示许多醒后中风发生在接近醒来时，因此患者就诊于急诊科时可能处于溶栓治疗的批准时间窗内。建议采用多种影像学方法来识别可能从溶栓治疗中获益的醒后中风患者，包括非增强CT、CT灌注成像、半暗带MRI以及最近提出的弥散加权成像-液体衰减反转恢复序列（DWI-FLAIR）概念。一些小型病例系列研究和观察性研究报告了醒后中风溶栓治疗的结果，未出现安全性问题，但这些研究无法得出关于疗效的结论。为此，目前正在进行基于影像学结果纳入醒后中风患者的临床试验，即DWI-FLAIR不匹配（WAKE-UP）试验或半暗带成像（EXTEND）试验。这些试验结果将为指导醒后中风的溶栓治疗提供依据，从而扩大这一庞大中风患者群体的治疗选择。
