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| Thrombolysis possible with stroke on awakening |
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16 February 2006
Computed tomography (CT) findings in patients who have symptoms of stroke on awakening have added support to the argument that many may be eligible for thrombolysis treatment.
"Approximately one-quarter of acute ischaemic stroke patients notice the stroke at awakening," state the Japanese researchers in the journal Cerebrovascular Diseases. Although the unknown time of onset usually excludes such patients from thrombolysis, a recent magnetic resonance imaging (MRI) study has suggested that many patients who have stroke symptoms on waking may in fact be eligible for such treatment. "In a clinical situation, however, CT rather than MRI is more widely used before thrombolytic treatment of hyperacute ischaemic stroke, because CT is more accessible," Dr Kenichi Todo and co-workers from the National Cardiovascular Centre in Osaka note.
The team therefore examined the CT findings of 81 patients with cardioembolic stroke who presented within 3 hours of stroke recognition. Of these patients, 46 had a recorded time of symptom onset, 17 had stroke on awakening, and 18 did not know, or were unable to communicate, the time of onset. Normal CT findings were seen in 30% of patients with known time of stroke onset and in 22% of those who had stroke on waking, while early signs of ischaemia were observed in 70% and 67% of patients with known onset and stroke on waking, respectively. No hypodense areas, which signify lesions, were found on the CT scans of patients with known time of stroke onset, compared with 11% on the scans of those with stroke on waking; however, this difference was not statistically significant. In contrast, no patient with an unknown time of stroke onset had normal CT findings, with 44% of this group showing early signs of ischaemia while 56% had hypodense areas.
"Judging from such CT findings, it can be said that stroke may in fact be developing shortly before awakening in a large subset of cardioembolic stroke patients whose stroke is noticed at awakening," the investigators conclude. They stress that these patients may be potential candidates for acute stroke therapies.
Reference:
Cerebrovasc Dis 2006; 21 (5-6): 367-371.
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