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Wake-Up Stroke versus Stroke with Known Onset Time: Clinical and Multimodality CT Imaging Characteristics.
Dankbaar, Jan W; Bienfait, Henri P; van den Berg, Coen; Bennink, Edwin; Horsch, Alexander D; van Seeters, Tom; van der Schaaf, Irene C; Kappelle, L Jaap; Velthuis, Birgitta K.
Afiliación
  • Dankbaar JW; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
  • Bienfait HP; Department of Neurology, Gelre Hospital Apeldoorn, Apeldoorn, the Netherlands.
  • van den Berg C; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
  • Bennink E; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
  • Horsch AD; Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands.
  • van Seeters T; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
  • van der Schaaf IC; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
  • Kappelle LJ; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
  • Velthuis BK; Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
Cerebrovasc Dis ; 45(5-6): 236-244, 2018.
Article en En | MEDLINE | ID: mdl-29772576
BACKGROUND: Current guidelines for the treatment of acute ischemic stroke are mainly based on the time between symptom onset and initiation of treatment. This time is unknown in patients with wake-up stroke (WUS). We investigated clinical and multimodality CT imaging characteristics on admission in patients with WUS and in patients with a stroke with a known onset time. METHODS: All patients were selected from a large prospective cohort study (Dutch acute stroke study). WUS patients last seen well > 4.5 and ≤4.5 h were separately compared to patients with a known onset time ≤4.5 h. In addition, WUS patients with a proximal occlusion of the anterior circulation last seen well > 6 and ≤6 h were separately compared to patients with a known onset time ≤6 h and a proximal occlusion. National Institute of Health Stroke Score, age, gender, history of atrial fibrillation, non-contrast CT (NCCT) Alberta Stroke Program Early CT Score (ASPECTS), CT-perfusion abnormalities, proximal occlusions, and collateral filling on CT angiography were compared between groups using the Mann-Whitney U test and Fisher's exact test. RESULTS: WUS occurred in 149/1,393 (10.7%) patients. Admission clinical and imaging characteristics of WUS patients last seen well > 4.5 h (n = 81) were not different from WUS patients last seen well ≤4.5 h (n = 68). Although WUS patients last seen well > 4.5 h had a significantly lower NCCT ASPECTS than patients with a known time of stroke symptom onset of ≤4.5 h (n = 1,026), 85.2% had an NCCT ASPECTS > 7 and 75% had a combination of favorable ASPECTS > 7 and good collateral filling. There were no statistically significant differences between the admission clinical and imaging characteristics of WUS patients with proximal occlusions last seen well > 6 h (n = 23), last seen well ≤6 h (n = 40), and patients with a known time to stroke symptom onset ≤6 h (n = 399). Of all WUS patients with proximal occlusions last seen well > 6 h, only 4.3% had severe ischemia (ASPECTS < 5), 13 (56.5%) had ASPECTS > 7 and good collateral filling. CONCLUSIONS: There are only minor differences between clinical and imaging characteristics of WUS patients and patients who arrive in the hospital within the time criteria for intravenous or endovascular treatment. Therefore, CT imaging may help to identify WUS patients who would benefit from treatment and rule out those patients with severe ischemia and poor collaterals.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Angiografía Cerebral / Accidente Cerebrovascular / Imagen de Perfusión / Imagen Multimodal / Tomografía Computarizada Multidetector / Angiografía por Tomografía Computarizada Tipo de estudio: Clinical_trials / Guideline / Observational_studies / Prognostic_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Cerebrovasc Dis Asunto de la revista: ANGIOLOGIA / CEREBRO Año: 2018 Tipo del documento: Article País de afiliación: Países Bajos

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Angiografía Cerebral / Accidente Cerebrovascular / Imagen de Perfusión / Imagen Multimodal / Tomografía Computarizada Multidetector / Angiografía por Tomografía Computarizada Tipo de estudio: Clinical_trials / Guideline / Observational_studies / Prognostic_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Cerebrovasc Dis Asunto de la revista: ANGIOLOGIA / CEREBRO Año: 2018 Tipo del documento: Article País de afiliación: Países Bajos