title: Wake-up Strokes Are Similar to Known-Onset Morning Strokes in Severity and Outcome.
abstract: BACKGROUND
  Stroke symptoms noticed upon waking, wake-up stroke, account for up to a quarter of all acute ischemic strokes. Patients with wake-up stroke, however, are often excluded from thrombolytic therapy.
  
  
  METHODS
  Using our prospectively collected stroke registry, wake-up stroke and known-onset morning strokes were identified. Wakeup stroke was defined as a patient who was asleep >3 hours and first noted stroke symptoms upon awakening between 0100 and 1100. Known-onset morning stroke was defined as a patient who had symptom onset while awake during the same time interval. We compared wake-up stoke to known-onset morning stroke with respect to patient demographics, stroke severity, etiology and outcomes.
  
  
  RESULTS
  One-quarter of patients with acute ischemic strokes (391/1415) had documented time between 0100 and 1100 of symptom onset: 141 (36%) wake-up strokes and 250 (64%) known-onset morning strokes. No difference in baseline characteristics, stroke severity, stroke etiology, neurologic deterioration, discharge disposition or functional outcome was detected. Known-onset morning stroke patients were significantly more likely to get thrombolytic therapy and have higher risk of in-hospital mortality. Wake-up stroke patients tended to be older, have higher diastolic blood pressure and have longer length of hospital stay.
  
  
  CONCLUSIONS
  While patients with wake-up stroke were similar to patients with known-onset morning stroke in many respects, patients with known onset morning stroke were significantly more likely to get treated with thrombolytic therapy and have higher in-hospital mortality.
authors.affiliation: Department of Neurology, Medstar Georgetown University Hospital, Washington, DC; Stroke Program, Department of Neurology, Tulane University School of Medicine, New Orleans, LA.
authors.forename: M C
authors.initials: MC
authors.lastname: Denny
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham; Department of Neurology, School of Medicine, University of Alabama at Birmingham.
authors.forename: A K
authors.initials: AK
authors.lastname: Boehme
authors.affiliation: Stroke Program, Department of Neurology, Tulane University School of Medicine, New Orleans, LA.
authors.forename: A M
authors.initials: AM
authors.lastname: Dorsey
authors.affiliation: Stroke Program, Department of Neurology, Tulane University School of Medicine, New Orleans, LA.
authors.forename: A J
authors.initials: AJ
authors.lastname: George
authors.affiliation: Stroke Program, Department of Neurology, Tulane University School of Medicine, New Orleans, LA.
authors.forename: A D
authors.initials: AD
authors.lastname: Yeh
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham; Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE); Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health and Health Disparities Research Center (MHRC); Department of Neurology, School of Medicine, University of Alabama at Birmingham.
authors.forename: K C
authors.initials: KC
authors.lastname: Albright
authors.affiliation: Stroke Program, Department of Neurology, Tulane University School of Medicine, New Orleans, LA.
authors.forename: S
authors.initials: S
authors.lastname: Martin-Schild
keywords: Acute ischemic stroke; Outcomes; Severity; Thrombolysis; Wake-up stroke
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