title: Ischemic stroke on awakening: patients' characteristics, outcomes and potential for reperfusion therapy.
abstract: BACKGROUND
  Reports on differences between patients with and without wake-up stroke are inconsistent. We studied the proportion, characteristics, and outcomes of wake-up ischemic stroke (IS) and estimated the number of potential candidates for reperfusion therapy in a national registry of hospitalized patients.
  
  
  METHODS
  IS patients in all three National Acute Stroke ISraeli (NASIS) registry periods (2004, 2007, and 2010; 2 months each) were included. In-hospital neurological complications, poor functional outcome (death, modified Rankin scale ≥ 2, or discharge to a nursing home), and in-hospital mortality were the study outcomes. Risks of poor outcomes were estimated with logistic regression analysis.
  
  
  RESULTS
  Wake-up IS was reported for 820/4,408 (18.6%) patients. Baseline characteristics were similar for patients with and without wake-up IS. ORs (95% CIs) for wake-up compared to non-wake-up IS were 1.2 (0.9-1.6) for neurological complications, 0.8 (0.7-0.98) for poor functional outcome, and 0.8 (0.5-1.2) for death. According to an estimated 20-40% prevalence of penumbra, wake-up stroke patients could add 3.7-7.4% to the number of patients potentially eligible for reperfusion therapy.
  
  
  CONCLUSIONS
  Stroke on awakening is present in almost one fifth of IS patients. Characteristics and stroke outcomes are similar for patients with and without wake-up IS. Confirmation of a valid approach for the detection of wake-up stroke patients who can potentially benefit from reperfusion therapy is essential.
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. koton@post.tau.ac.il
authors.forename: Silvia
authors.initials: S
authors.lastname: Koton
authors.forename: David
authors.initials: D
authors.lastname: Tanne
authors.forename: Natan M
authors.initials: NM
authors.lastname: Bornstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000401:mortality* / Q000628:therapy*; D002548:Cerebral Revascularization; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D018579:Patient Selection; D015995:Prevalence; D012042:Registries / Q000706:statistics & numerical data; D012890:Sleep; D020521:Stroke / Q000401:mortality* / Q000628:therapy*; D014851:Wakefulness