Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada Di Fiume, 447 - 34149, Trieste, Italy.
Neurol Sci. 2024 Oct;45(10):4871-4879. doi: 10.1007/s10072-024-07597-3. Epub 2024 May 21.
Wake-up Stroke (WUS) accounts for about 25% of all ischemic strokes. Differences according to sex in the WUS subgroup has been poorly investigated so far, so we aimed to assess these differences by differentiating the enrolled population based on treatment administered.
MATERIALS & METHODS: We retrospectively analysed clinical and imaging data of WUS patients admitted to our hospital between November 2013 and December 2018 dividing them in two groups: rTPA-treated and non-rTPA treated group. To point out outcome differences we evaluated: NIHSS at 7 days or at discharge, mRS at discharge and ΔNIHSS.
We enrolled 149 WUS patients, 74 rTPA treated and 75 non-rTPA treated. Among rTPA treated patients, time from last known well (LKW) to Emergency Department (ED) admission was longer in females than males (610 vs 454 min), while females had a higher ΔNIHSS than males (5 vs 3). Finally, among non-rTPA treated patients, females were older than males (85 vs 79 years), had a higher pre-admission mRS (although very low in both cases), had a longer length of stay (17 vs 13 days) and shown a higher NIHSS at discharge (4 vs 2) compared to males.
Females not receiving thrombolytic treatment had worse functional outcome than males, showing a higher NIHSS at discharge but, in contrast, when treated with rTPA they showed better neurological recovery as measured by a greater ΔNIHSS. We emphasize the importance of a prompt recognition of WUS in females since they seem to benefit more from rTPA treatment.
觉醒性卒中（WUS）约占所有缺血性卒中的 25%。迄今为止，对于 WUS 亚组中性别差异的研究甚少，因此我们旨在通过根据所给予的治疗对入组人群进行区分，来评估这些差异。
我们回顾性分析了 2013 年 11 月至 2018 年 12 月期间我院收治的 WUS 患者的临床和影像学数据，将其分为 rTPA 治疗组和非 rTPA 治疗组。为了指出预后差异，我们评估了：7 天或出院时 NIHSS、出院时 mRS 和ΔNIHSS。
我们纳入了 149 例 WUS 患者，其中 74 例接受 rTPA 治疗，75 例未接受 rTPA 治疗。在 rTPA 治疗组中，女性从最后一次状态良好（LKW）到急诊就诊的时间长于男性（610 分钟比 454 分钟），而女性的ΔNIHSS 高于男性（5 分比 3 分）。最后，在非 rTPA 治疗组中，女性比男性年龄更大（85 岁比 79 岁），入院前 mRS 更高（尽管在两种情况下都非常低），住院时间更长（17 天比 13 天），出院时 NIHSS 更高（4 分比 2 分）。
未接受溶栓治疗的女性功能预后较男性差，出院时 NIHSS 较高，但相反，当接受 rTPA 治疗时，她们的神经功能恢复更好，ΔNIHSS 更大。我们强调了及时识别女性 WUS 的重要性，因为她们似乎从 rTPA 治疗中获益更多。
