Format

Send to

Choose Destination
See comment in PubMed Commons below
Stroke. 2017 Feb 7. pii: STROKEAHA.116.015233. doi: 10.1161/STROKEAHA.116.015233. [Epub ahead of print]

Stroke With Unknown Time of Symptom Onset: Baseline Clinical and Magnetic Resonance Imaging Data of the First Thousand Patients in WAKE-UP.

Author information

  • 1From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum (G.T., B.C., C.G.) and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum (J.F.), Universitätsklinikum Hamburg-Eppendorf, Germany; Service de Biostatistique, Hospices Civils de Lyon, France (F.B., P.R.); Université Lyon 1, Villeurbanne, France (F.B., P.R.); CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France (F.B., P.R.); Centrum für Schlaganfallforschung Berlin (CSB) (J.B.F., I.G., M. Ebinger, M. Endres) and Klinik und Hochschulambulanz für Neurologie (M. Ebinger, M. Endres), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology, Aarhus University Hospital, Denmark (C.Z.S.); Department of Neurology, Hospices Civils de Lyon, France (N.N., T.-H.C.); Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investgació Biomèdica de Girona (IDIBGI), Spain (S.P., J.P.); Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, VIB Center for Brain & Disease Research, and Department of Neurology, University Hospitals Leuven, Belgium (R.L.); Institute of Neuroscience and Psychology (K.W.M.) and Robertson Centre for Biostatistics (I.F.), University of Glasgow, United Kingdom; and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (V.T.). thomalla@uke.de.
  • 2From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum (G.T., B.C., C.G.) and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum (J.F.), Universitätsklinikum Hamburg-Eppendorf, Germany; Service de Biostatistique, Hospices Civils de Lyon, France (F.B., P.R.); Université Lyon 1, Villeurbanne, France (F.B., P.R.); CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France (F.B., P.R.); Centrum für Schlaganfallforschung Berlin (CSB) (J.B.F., I.G., M. Ebinger, M. Endres) and Klinik und Hochschulambulanz für Neurologie (M. Ebinger, M. Endres), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology, Aarhus University Hospital, Denmark (C.Z.S.); Department of Neurology, Hospices Civils de Lyon, France (N.N., T.-H.C.); Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investgació Biomèdica de Girona (IDIBGI), Spain (S.P., J.P.); Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, VIB Center for Brain & Disease Research, and Department of Neurology, University Hospitals Leuven, Belgium (R.L.); Institute of Neuroscience and Psychology (K.W.M.) and Robertson Centre for Biostatistics (I.F.), University of Glasgow, United Kingdom; and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (V.T.).

Abstract

BACKGROUND AND PURPOSE:

We describe clinical and magnetic resonance imaging (MRI) characteristics of stroke patients with unknown time of symptom onset potentially eligible for thrombolysis from a large prospective cohort.

METHODS:

We analyzed baseline data from WAKE-UP (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke: A Randomized, Doubleblind, Placebo-Controlled Trial), an investigator-initiated, randomized, placebo-controlled trial of MRI-based thrombolysis in stroke patients with unknown time of symptom onset. MRI judgment included assessment of the mismatch between visibility of the acute ischemic lesion on diffusion-weighted imaging and fluid-attenuated inversion recovery.

RESULTS:

Of 1005 patients included, diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch was present in 479 patients (48.0%). Patients with daytime-unwitnessed stroke (n=138, 13.7%) had a shorter delay between symptom recognition and hospital arrival (1.5 versus 1.8 hours; P=0.002), a higher National Institutes of Stroke Scale score on admission (8 versus 6; P<0.001), and more often aphasia (72.5% versus 34.0%; P<0.001) when compared with stroke patients waking up from nighttime sleep. Frequency of diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch was comparable between both groups (43.7% versus 48.7%; P=0.30).

CONCLUSIONS:

Almost half of the patients with unknown time of symptom onset stroke otherwise eligible for thrombolysis had MRI findings making them likely to be within a time window for safe and effective thrombolysis. Patients with daytime onset unwitnessed stroke differ from wake-up stroke patients with regards to clinical characteristics but are comparable in terms of MRI characteristics of lesion age.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01525290. URL: https://www.clinicaltrialsregister.eu. Unique identifier: 2011-005906-32.

KEYWORDS:

aphasia; informed consent; magnetic resonance imaging; risk factors; stroke

PMID:
28174327
DOI:
10.1161/STROKEAHA.116.015233
[PubMed - as supplied by publisher]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire
    Loading ...
    Support Center