Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy.
Radiology Unit, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy.
Neurol Sci. 2018 Oct;39(10):1705-1712. doi: 10.1007/s10072-018-3486-z. Epub 2018 Jul 10.
Ischemic stroke is a neuroemergency condition highly treatable with thrombolysis and thrombectomy. Recently, observational studies have brought insights into clinical and imaging characteristics of wake-up stroke, which interested up to 25% of ischemic stroke patients. In clinical practice, wake-up strokes are usually not considered for reperfusion therapy. The aim of this study was to investigate the use CT perfusion imaging in patients with wake-up stroke and to assess the effect of neuroimaging information provided by CT perfusion maps on the efficacy and safety of thrombolysis and thrombectomy.
We studied 22 wake-up stroke (WUS) patients (13F/9M mean age) who underwent reperfusion therapy after the eligibility assessed by the CT perfusion imaging (< 50% core-to-penumbra ratio and negative CT perfusion).
Mean National Institutes of Health Stroke Scale (NIHSS) was 8.1 ± 4.9 at admission while 3.3 ± 5.1 at discharge, significantly different from admission (p < 0.001). As many as ten patients had mRS lower than 3 at discharge. Intracranial hemorrhage occurred in five patients and caused symptoms worsening only in two patients (decrease of NIHSS score of 4 points) of which one patient died.
The main finding of this study is that wake-up stroke with adequate selection by CT perfusion may benefit reperfusion treatment.
缺血性脑卒中是一种可通过溶栓和取栓治疗的神经急症。最近，观察性研究深入探讨了觉醒型脑卒中的临床和影像学特征，多达 25%的缺血性脑卒中患者属于觉醒型脑卒中。在临床实践中，觉醒型脑卒中通常不考虑进行再灌注治疗。本研究旨在探讨 CT 灌注成像在觉醒型脑卒中患者中的应用，并评估 CT 灌注图提供的神经影像学信息对溶栓和取栓治疗效果和安全性的影响。
我们研究了 22 例觉醒型脑卒中（WUS）患者（13 例女性/9 例男性，平均年龄），这些患者在 CT 灌注成像评估后（<50%核心-半影比值和 CT 灌注阴性）符合再灌注治疗的标准。
入院时的平均国立卫生研究院卒中量表（NIHSS）评分为 8.1±4.9，出院时为 3.3±5.1，与入院时相比差异显著（p<0.001）。出院时，多达 10 名患者的 mRS 评分低于 3。5 名患者发生颅内出血，其中仅 2 名患者症状加重（NIHSS 评分下降 4 分），其中 1 名患者死亡。
本研究的主要发现是，通过 CT 灌注适当选择的觉醒型脑卒中可能受益于再灌注治疗。
