wake-up stroke

Q: What is a "wake-up" stroke?

Answer: "Wake up" label is applied to patients who notice stroke symptoms on waking up from sleep. In such situations, stroke timing criteria should be established from the last time known to be normal; usually the time they went to bed. Family members can also be inquired about when they observed the patient in a normal functional status last time. 

If this time period is more than 4.5 hours, patients are usually not eligible for thrombolytic therapy. An alternative is to perform an MRI, which may show an acute ischemic stroke that is diffusion-positive and FLAIR-negative.

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References:

1. Peter-Derex L, Derex L. Wake-up stroke: From pathophysiology to management. Sleep Med Rev. 2019 Dec;48:101212. doi: 10.1016/j.smrv.2019.101212. Epub 2019 Sep 23. PMID: 31600679.

2. Tsai JP, Albers GW. Wake-Up Stroke: Current Understanding. Top Magn Reson Imaging. 2017 Jun;26(3):97-102. doi: 10.1097/RMR.0000000000000126. PMID: 28277462.

3. Rimmele DL, Thomalla G. Wake-up stroke: clinical characteristics, imaging findings, and treatment option - an update. Front Neurol. 2014 Mar 26;5:35. doi: 10.3389/fneur.2014.00035. PMID: 24723908; PMCID: PMC3972483.

4. Rubin MN, Barrett KM. What to do With Wake-Up Stroke. Neurohospitalist. 2015 Jul;5(3):161-72. doi: 10.1177/1941874415576204. PMID: 26288674; PMCID: PMC4530419.