title: Feasibility and safety of magnetic resonance imaging-based thrombolysis in patients with stroke on awakening: initial single-centre experience.
abstract: BACKGROUND
  Up to 25% of all acute ischaemic strokes occur during sleep. Because of the unclear time window, patients with stroke on awakening are usually not considered for acute therapy and excluded from most acute treatment trials.
  
  
  OBJECTIVE
  To evaluate the feasibility of magnetic resonance imaging-based intravenous thrombolysis in patients with stroke on awakening in a routine clinical setting.
  
  
  METHODS
  Forty-five patients with stroke on awakening clinically qualifying for intravenous thrombolysis and presenting within 6 h after symptom recognition were admitted to our institution between October 2006 and May 2008. Following an institutional protocol, patients received magnetic resonance imaging as a first-line imaging modality and were offered mismatch-based thrombolysis whenever possible. Baseline demographic data, clinical, laboratory and imaging findings were analysed. Outcome was assessed using the modified Rankin Scale score at 3 months.
  
  
  RESULTS
  Magnetic resonance imaging screening was feasible in 43/45 patients (96%). After screening, 10 patients (22%) were treated with intravenous thrombolysis. There were no differences between treated and untreated patients regarding cardiovascular risk factors, stroke aetiology, previous prophylactic treatment and symptom recognition to door time or door to imaging time. Outcome was comparable in both groups despite a trend towards more severe strokes in the intravenous thrombolysis group. Only one asymptomatic and no symptomatic haemorrhage were observed.
  
  
  CONCLUSIONS
  Our data demonstrate that magnetic resonance imaging-based thrombolysis is feasible and possibly safe in patients with stroke on awakening (SOA). Randomised clinical trials for patients with stroke on awakening are needed to further test the safety and efficacy of intravenous thrombolysis in this patient group. The results of our study may help to initiate and design such studies.
authors.affiliation: Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Breuer
authors.forename: P D
authors.initials: PD
authors.lastname: Schellinger
authors.forename: H B
authors.initials: HB
authors.lastname: Huttner
authors.forename: R
authors.initials: R
authors.lastname: Halwachs
authors.forename: T
authors.initials: T
authors.lastname: Engelhorn
authors.forename: A
authors.initials: A
authors.lastname: Doerfler
authors.forename: M
authors.initials: M
authors.lastname: Köhrmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D000075202:Contraindications; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D021641:Recognition, Psychology; D012449:Safety; D012890:Sleep; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology* / Q000503:physiopathology; D015912:Thrombolytic Therapy / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D014851:Wakefulness / Q000502:physiology*
chemical_list: D005343:Fibrinolytic Agents