Costa Ricardo, Pinho João, Alves José Nuno, Amorim José Manuel, Ribeiro Manuel, Ferreira Carla
School of Health Sciences, University of Minho, Portugal.
Neurology Department, Hospital de Braga, Portugal.
J Stroke Cerebrovasc Dis. 2016 Mar;25(3):511-4. doi: 10.1016/j.jstrokecerebrovasdis.2015.10.032. Epub 2015 Nov 27.
Wake-up stroke (WUS) represents 25% of all ischemic strokes. There is conflicting evidence concerning clinical severity, imaging characteristics, and outcome when WUS is compared with stroke of known time of onset. Our aim was to compare WUS patients with patients with ischemic stroke within the therapeutic window (STW) for thrombolysis.
This is a retrospective hospital-based study of all consecutive patients hospitalized for acute ischemic stroke during 2013. Patients with STW, WUS, and WUS with computed tomography (CT) at 3 hours or less after awakening (WUS≤3h) were selected for the study. The methods used include a review of clinical records, an independent quantification of early signs of ischemia on admission CT scan, and determination of functional outcome on follow-up.
Of 554 patients evaluated, 190 had STW, 113 had WUS (20.4%), and 25 had WUS≤3h. Among all WUS patients, 33.6% did not have any other formal contraindication for thrombolysis besides undetermined time of onset. WUS patients had demographic characteristics, vascular risk factors, and clinical severity similar to STW patients. Mild or absent early signs of ischemia on admission CT in WUS≤3h patients were similar to those in STW patients when adjusted for clinical severity (odds ratio [OR] = .50, 95% confidence interval [CI]=.17-1.47). Favorable prognosis in WUS≤3h was similar to STW when adjusted for age, clinical severity, and thrombolysis (OR = .53, 95% CI=.09-3.14).
This study strengthens the evidence that clinical and early imaging characteristics of WUS patients are similar to those of patients with stroke who are eligible for thrombolysis based on the time window criteria, and patients with WUS do not have a worse short outcome.
醒后卒中（WUS）占所有缺血性卒中的25%。在将WUS与已知发病时间的卒中进行比较时，关于临床严重程度、影像学特征和预后存在相互矛盾的证据。我们的目的是比较WUS患者与处于溶栓治疗时间窗内的缺血性卒中（STW）患者。
这是一项基于医院的回顾性研究，研究对象为2013年期间因急性缺血性卒中连续住院的所有患者。选择STW患者、WUS患者以及醒来后3小时或更短时间内进行计算机断层扫描（CT）的WUS患者（WUS≤3h）纳入研究。所采用的方法包括查阅临床记录、对入院CT扫描上缺血早期征象进行独立量化以及随访时确定功能预后。
在评估的554例患者中，190例为STW患者，113例为WUS患者（20.4%），25例为WUS≤3h患者。在所有WUS患者中，33.6%除发病时间未确定外没有其他正式的溶栓禁忌证。WUS患者的人口统计学特征、血管危险因素和临床严重程度与STW患者相似。在根据临床严重程度进行调整后，WUS≤3h患者入院CT上缺血早期征象轻微或无的情况与STW患者相似（比值比[OR]=0.50，95%置信区间[CI]=0.17 - 1.47）。在根据年龄、临床严重程度和溶栓情况进行调整后，WUS≤3h患者的良好预后与STW患者相似（OR=0.53，95% CI=0.09 - 3.14）。
本研究强化了以下证据，即WUS患者的临床和早期影像学特征与基于时间窗标准符合溶栓条件的卒中患者相似，且WUS患者的短期预后并不更差。
