title: Alberta Stroke Program Early CT Score (ASPECTS) in patients with wake-up stroke.
abstract: One-quarter of ischemic strokes occur during sleep, and affected patients are excluded from thrombolytic therapy because of an unknown time of stroke onset. It has been suggested that early ischemic changes detected on computed tomography (CT) are similar in patients with acute stroke and patients who recently awoke with stroke. We compared head CT scans using the Alberta Stroke Program Early CT Score (ASPECTS) in patients who were likely to suffer their stroke during sleep (awoke group) and a control group of patients with stroke of known onset time. Patients were recruited from a prospectively collected acute stroke database. The awoke group was defined as all ischemic stroke patients who were "last seen normal" more than 4 hours ago, arrived between 4 a.m. and 10 a.m., and underwent head CT within 15 hours of the time last seen normal. The control group was randomly selected from patients who underwent head CT within 4 hours of stroke onset. The ASPECTS evaluations were performed by investigators blinded to patient group and time of onset. A modified Rankin Scale (mRS) score was available in 15 awoke patients and 46 control patients at 90 days after stroke. Twenty-eight awoke patients and 68 control patients had suitable imaging for the ASPECTS. Baseline demographic characteristics and risk factors were similar in the 2 groups. The dichotomized ASPECTS analysis (≤7 vs 8-10) showed no significant differences between the groups. ASPECTS was 8-10 in 89.3% the awoke group and 95.6% in the control group (P=.353). There was a trend toward higher 90-day mRS score (0-1) in the awoke group versus controls (73% vs 45%; P=.079). Initial ASPECTS was similar in patients with wake-up stroke and those with 4 hours of symptoms. This suggests that a subset of wake-up stroke patients might be suitable for thrombolytic therapy.
authors: Department of Neurosciences, University of California San Diego, San Diego, California 92103-8466, USA. bhuisagarate@ucsd.edu
authors: Branko N
authors: BN
authors: Huisa
authors: Rema
authors: R
authors: Raman
authors: Karin
authors: K
authors: Ernstrom
authors: Gilda
authors: G
authors: Tafreshi
authors: Andrew
authors: A
authors: Stemer
authors: Brett C
authors: BC
authors: Meyer
authors: Thomas
authors: T
authors: Hemmen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California; D016022:Case-Control Studies; D019992:Databases as Topic; D004185:Disability Evaluation; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D015912:Thrombolytic Therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014851:Wakefulness