Department of Neurology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK.
Int J Stroke. 2015 Apr;10(3):331-5. doi: 10.1111/ijs.12388. Epub 2014 Oct 22.
Debate exists as to whether wake-up stroke (WUS) (i.e. symptoms first noted on waking) differs from stroke developing while awake [awake onset stroke (AOS)]. Unknown onset stroke (UOS) with unclear symptom onset time is infrequently studied.
This study aimed to examine differences in stroke characteristics and outcomes in these three groups.
The stroke registry database from Halifax Infirmary, Canada, was interrogated for hospitalised stroke patients between 1999-2011. Information was available on demographics, stroke characteristics, and functional status at discharge and six months (modified Rankin score [mRS]).
Of 3890 patients, 65% had AOS, 21% WUS and 14% UOS. UOS patients were significantly older, more commonly female and living alone than AOS patients, with no difference between AOS and WUS. UOS rates increased from 10 to 16% of patients during the study period (P < 0.0001). UOS but not WUS had a higher stroke severity than AOS. Intracerebral hemorrhage was less common (9 vs. 13%) and lacunar stroke more common (23 vs. 19%) in WUS compared to AOS. In UOS left hemisphere location was more likely, and lacunar stroke less common. Excellent outcomes were slightly lower for WUS. UOS had significantly higher rates of in-hospital mortality (23 vs. 16%, P < 0.0001) and poorer functional outcome six months after stroke (mRS < 3 in 26% of UOS and 46% of AOS, P = 0.02).
WUS has lower rates of ICH but similar stroke severity and outcomes to AOS. UOS prevalence appears to be increasing, with higher stroke severity and worse prognosis.
关于觉醒性卒中（WUS）（即醒来时首次出现的症状）是否与清醒时发生的卒中（AOS）不同存在争议。对于不明发病时间的卒中（UOS），其发病时间尚不清楚，研究较少。
本研究旨在研究这三组患者在卒中特征和结局方面的差异。
对加拿大哈利法克斯综合医院的卒中登记数据库进行检索，获取 1999 年至 2011 年期间住院的卒中患者信息。信息包括人口统计学特征、卒中特征以及出院和 6 个月时的功能状态（改良 Rankin 评分[mRS]）。
在 3890 名患者中，65%为 AOS，21%为 WUS，14%为 UOS。UOS 患者明显比 AOS 患者年龄更大、更常见女性且独居，而 AOS 和 WUS 之间无差异。在此研究期间，UOS 患者的比例从 10%增加到 16%（P<0.0001）。与 AOS 相比，UOS 而非 WUS 的卒中严重程度更高。WUS 患者颅内出血较少（9%比 13%），腔隙性卒中更常见（23%比 19%）。在 UOS 中，左侧半球病变更为常见，腔隙性卒中也较少见。WUS 的良好结局略低。UOS 的住院死亡率明显更高（23%比 16%，P<0.0001），卒中后 6 个月的功能结局较差（mRS<3 的患者 UOS 占 26%，AOS 占 46%，P=0.02）。
WUS 的 ICH 发生率较低，但与 AOS 的卒中严重程度和结局相似。UOS 的患病率似乎在增加，且卒中严重程度更高，预后更差。
