Denny M C, Boehme A K, Dorsey A M, George A J, Yeh A D, Albright K C, Martin-Schild S
Department of Neurology, Medstar Georgetown University Hospital, Washington, DC; Stroke Program, Department of Neurology, Tulane University School of Medicine, New Orleans, LA.
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham; Department of Neurology, School of Medicine, University of Alabama at Birmingham.
J Neurol Neurol Disord. 2014 Dec;1(1). doi: 10.15744/2454-4981.1.102. Epub 2014 Dec 29.
Stroke symptoms noticed upon waking, wake-up stroke, account for up to a quarter of all acute ischemic strokes. Patients with wake-up stroke, however, are often excluded from thrombolytic therapy.
Using our prospectively collected stroke registry, wake-up stroke and known-onset morning strokes were identified. Wakeup stroke was defined as a patient who was asleep >3 hours and first noted stroke symptoms upon awakening between 0100 and 1100. Known-onset morning stroke was defined as a patient who had symptom onset while awake during the same time interval. We compared wake-up stoke to known-onset morning stroke with respect to patient demographics, stroke severity, etiology and outcomes.
One-quarter of patients with acute ischemic strokes (391/1415) had documented time between 0100 and 1100 of symptom onset: 141 (36%) wake-up strokes and 250 (64%) known-onset morning strokes. No difference in baseline characteristics, stroke severity, stroke etiology, neurologic deterioration, discharge disposition or functional outcome was detected. Known-onset morning stroke patients were significantly more likely to get thrombolytic therapy and have higher risk of in-hospital mortality. Wake-up stroke patients tended to be older, have higher diastolic blood pressure and have longer length of hospital stay.
While patients with wake-up stroke were similar to patients with known-onset morning stroke in many respects, patients with known onset morning stroke were significantly more likely to get treated with thrombolytic therapy and have higher in-hospital mortality.
醒来时出现的中风症状，即醒后中风，占所有急性缺血性中风的四分之一。然而，醒后中风患者通常被排除在溶栓治疗之外。
利用我们前瞻性收集的中风登记资料，确定醒后中风和已知发病时间的晨起中风患者。醒后中风定义为入睡超过3小时且在01:00至11:00之间醒来时首次出现中风症状的患者。已知发病时间的晨起中风定义为在同一时间间隔内清醒时出现症状的患者。我们比较了醒后中风和已知发病时间的晨起中风患者的人口统计学特征、中风严重程度、病因及预后。
四分之一的急性缺血性中风患者（391/1415）记录的症状发作时间在01:00至11:00之间：141例（36%）为醒后中风，250例（64%）为已知发病时间的晨起中风。未发现两组患者在基线特征、中风严重程度、中风病因、神经功能恶化、出院处置或功能预后方面存在差异。已知发病时间的晨起中风患者接受溶栓治疗的可能性显著更高，且院内死亡风险更高。醒后中风患者往往年龄更大，舒张压更高，住院时间更长。
虽然醒后中风患者在许多方面与已知发病时间的晨起中风患者相似，但已知发病时间的晨起中风患者接受溶栓治疗的可能性显著更高，且院内死亡风险更高。
