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Wake-up stroke and stroke of unknown onset: a critical review.

Wouters A, Lemmens R, Dupont P, Thijs V - Front Neurol (2014)

Bottom Line: Currently, this subset of patients is excluded from revascularization-therapy since no exact time of onset is known.The different imaging-selection criteria that can be used to treat these patients are discussed.Additional research on imaging findings associated with recent stroke and penumbral imaging will eventually lead to a shift from a rigid time-frame based therapy to a tissue-based individualized treatment approach.

View Article: PubMed Central - PubMed

Affiliation: KU Leuven Department of Neurosciences and Experimental Neurology, KU Leuven , Leuven , Belgium ; Department of Neurology, University Hospital Leuven , Leuven , Belgium ; Medical Imaging Research Center, UZ Leuven , Leuven , Belgium.

ABSTRACT
Patients, who wake up with an ischemic stroke, account for a large number of the total stroke population, due to circadian morning predominance of stroke. Currently, this subset of patients is excluded from revascularization-therapy since no exact time of onset is known. A large group of these patients might be eligible for therapy. In this review, we assessed the current literature about the hypothesis that wake-up-strokes occur just prior on awakening and if this subgroup differs in characteristics compared to the overall stroke population. We looked at the safety and efficacy of thrombolysis and interventional techniques in the group of patients with unknown stroke-onset. We performed a meta-analysis of the diagnostic accuracy of the diffusion-FLAIR mismatch in identifying stroke within 3 and 4.5 h. The different imaging-selection criteria that can be used to treat these patients are discussed. Additional research on imaging findings associated with recent stroke and penumbral imaging will eventually lead to a shift from a rigid time-frame based therapy to a tissue-based individualized treatment approach.

No MeSH data available.


Related in: MedlinePlus

Morning changes in cardiovascular factors contributing to a higher risk of stroke in the morning hours. Adapted from Ref. (23).
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Figure 1: Morning changes in cardiovascular factors contributing to a higher risk of stroke in the morning hours. Adapted from Ref. (23).

Mentions: Exogenous factors can play an additional role. The variation in circulatory factors can be a consequence of an early-morning response to arousal and physical activity in the awakening state (23). Data suggest a different response to exercise in the morning, with a blunting of the normal blood pressure lowering effects of exercise. Additionally, an association was found between the very common obstructive sleep apnoe syndrome (OSA) and the occurrence of wake-up-strokes (24). OSA is associated with intermittent hypoxemia and sympathetic overactivity, which increases the cardiovascular risk profile and possibly the prevalence of wake-up-strokes as well (Figure 1).


Wake-up stroke and stroke of unknown onset: a critical review.

Wouters A, Lemmens R, Dupont P, Thijs V - Front Neurol (2014)

Morning changes in cardiovascular factors contributing to a higher risk of stroke in the morning hours. Adapted from Ref. (23).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4129498&req=5

Figure 1: Morning changes in cardiovascular factors contributing to a higher risk of stroke in the morning hours. Adapted from Ref. (23).
Mentions: Exogenous factors can play an additional role. The variation in circulatory factors can be a consequence of an early-morning response to arousal and physical activity in the awakening state (23). Data suggest a different response to exercise in the morning, with a blunting of the normal blood pressure lowering effects of exercise. Additionally, an association was found between the very common obstructive sleep apnoe syndrome (OSA) and the occurrence of wake-up-strokes (24). OSA is associated with intermittent hypoxemia and sympathetic overactivity, which increases the cardiovascular risk profile and possibly the prevalence of wake-up-strokes as well (Figure 1).

Bottom Line: Currently, this subset of patients is excluded from revascularization-therapy since no exact time of onset is known.The different imaging-selection criteria that can be used to treat these patients are discussed.Additional research on imaging findings associated with recent stroke and penumbral imaging will eventually lead to a shift from a rigid time-frame based therapy to a tissue-based individualized treatment approach.

View Article: PubMed Central - PubMed

Affiliation: KU Leuven Department of Neurosciences and Experimental Neurology, KU Leuven , Leuven , Belgium ; Department of Neurology, University Hospital Leuven , Leuven , Belgium ; Medical Imaging Research Center, UZ Leuven , Leuven , Belgium.

ABSTRACT
Patients, who wake up with an ischemic stroke, account for a large number of the total stroke population, due to circadian morning predominance of stroke. Currently, this subset of patients is excluded from revascularization-therapy since no exact time of onset is known. A large group of these patients might be eligible for therapy. In this review, we assessed the current literature about the hypothesis that wake-up-strokes occur just prior on awakening and if this subgroup differs in characteristics compared to the overall stroke population. We looked at the safety and efficacy of thrombolysis and interventional techniques in the group of patients with unknown stroke-onset. We performed a meta-analysis of the diagnostic accuracy of the diffusion-FLAIR mismatch in identifying stroke within 3 and 4.5 h. The different imaging-selection criteria that can be used to treat these patients are discussed. Additional research on imaging findings associated with recent stroke and penumbral imaging will eventually lead to a shift from a rigid time-frame based therapy to a tissue-based individualized treatment approach.

No MeSH data available.


Related in: MedlinePlus