Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Diagnosing a wake-up stroke (look to the future) - imaging, implications on treatment

762 views

Published on

Diagnosing a wake-up stroke by Fernanda Bellolio

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Diagnosing a wake-up stroke (look to the future) - imaging, implications on treatment

  1. 1. M. Fernanda Bellolio, MD, MS Department of Emergency Medicine and Health Sciences Research Mayo Clinic, United States Wake-up Stroke
  2. 2. • 20% stroke patients awaken with deficits • 10% have unclear time of symptoms onset Most therapies not approved for wake up strokes
  3. 3. Half of wake up strokes within treatable window
  4. 4. Imaging to Guide • Non contrast CT: ICH or early ischemic signs • Perfusion–Diffusion MRI or CT: Tissue at risk • DWI–FLAIR Mismatch: Lesion age • DWI: 3 mins • FLAIR: 3-6 hrs
  5. 5. Images courtesy of Dr. Alejandro Rabinstein • Infarcted tissue DWI or volume • At-risk tissue (penumbra) PWI or flow • Mismatch
  6. 6. Show me the evidence… • tPA in wake-up stroke • Endovascular treatment in wake-up stroke • Clinical approach
  7. 7. Ongoing Trials of Stroke of Unknown Onset Thomalla G and Gerloff C. Stroke. 2015;46:2707-2713.
  8. 8. tPA or not tPA? • Not FDA approved for wake up strokes • MR WITNESS, WAKE-UP and SAIL-ON single arm, no controls • Low rates of sICH and “likely” efficacy
  9. 9. Endovascular therapy
  10. 10. Approach to the patient w/ wake up stroke • Treat as an emergency • History, NIHSS, labs • CT followed by CTA and multiparametric CT or MRI • Use protocols (pagers, stroke codes, pharmacist, etc.)
  11. 11. • No routine therapy can be offered based on available evidence • Multiple ongoing trials will guide • Beware of “hyper-selection” of patients in RCT Approach to the patient w/ wake up stroke
  12. 12. Summary • Treat as an emergency • Imaging • Evidence is growing
  13. 13. The future is bright for ischemic stroke treatment but work remains to be done

×