Table 1.
Wake-Up Stroke Characteristics by Study.
| Authors | Study Design | Total Patients | Wake-Up Stroke #, % | Clinical Differences vs While-Awake Stroke | Outcome Differences vs While-Awake Stroke | Imaging |
|---|---|---|---|---|---|---|
| CASPR group8 | Retrospective, prospectively collected data, US state registry | 374 | 30 (8) | — | — | — |
| Michel et al9 | Retrospective, prospectively collected data, hospital registry | 1633 | 568 (33.1) | — | — | — |
| Tanimoto et al10 | Retrospective, prospectively collected data, hospital registry | 72 | 28 (38.9) | WUS: tended to be African American, younger, small vessel mechanism, less severe NIHSS, worse lipid profile | — | — |
| Marler et al11 | Retrospective, prospectively collected data, hospital registry | 1167 | 331 (28) | — | — | — |
| Ricci et al12 | Retrospective, prospectively collected data, regional registry | 375 | 68 (18.1) | — | — | — |
| Lago et al13 | Retrospective, prospectively collected data, hospital registry | 1223 | 309 (25.2) | — | — | — |
| Bornstein et al14 | Retrospective, prospectively collected data, national registry | 1671 | 311 (18.6) | WUS more severe | — | — |
| Chaturvedi et al15 | Subanalysis of prospective RCT | 1272 | 323 (25.4) | — | — | — |
| Serena et al16 | Retrospective, prospectively collected data, national registry | 1248 | 301 (24.1) | None | — | WUS: CT head normal in 39.4% of patients seen within 6 hours of symptom recognition (60% in stroke while awake) |
| Nadeau et al17 | Retrospective, prospectively collected data, national registry | 2585 | 349 (13.5) | WUS had higher BP and ischemic stroke subtype | WUS less likely to return home | — |
| Boode et al18 | Retrospective, hospital registry | 263 | 48 (18.3) | — | — | — |
| Jiménez-Conde et al19 | Retrospective, prospectively collected data, hospital registry | 813 | 127 (15.6) | WUS had more obesity, less AF, and higher initial stroke severity | WUS had worse 3-month outcome | — |
| Silva et al20 | Prospective cohort study, hospital registry | 676 | 131 (19.4) | None | None | Similar prevalence of CTP mismatch and arterial occlusion in WUS and known onset groups |
| Turin et al21 | Retrospective, prospectively collected data, national registry | 897 | 87 (9.7) | WUS more hypertension and increased initial severity | None | — |
| Fink et al22 | Retrospective, prospectively collected data, hospital registry | 364 | 100 (27) | None | — | Similar prevalence of MRI DWI/PWI mismatch |
| Moradiya et al23 | Subanalysis of a prospective RCT | 17 398 | 5152 (29.6) | WUS initially less severe | None | — |
| Koton et al24 | Retrospective, prospectively collected data, national registry | 4408 | 820 (18.6) | None | None | 20%-40% prevalence of penumbra |
| Todo et al25 | Retrospective, prospectively collected data, hospital registry | 158 | 17 (10.8) | — | — | CT findings in WUS similar to patients within 3 hours of known symptom onset |
| Huisa et al26 | Prospective cohort study, hospital registry | 96 | 28 (29.6) | None | Trend toward favorable (0-1) 90 d mRS in WUS vs 4 hours from symptoms controls (73% vs 45%) | Favorable CT ASPECTS (8-10) similar in WUS and known 4 h from symptoms (89.3% vs 95.6%) |
| Mackey et al27 | Population-based registry | 1854 | 273 (14.7) | “Minor differences” in age and rNIHSS (WUS older, higher rNIHSS) | None | — |
| Roveri et al28 | Retrospective, prospectively collected data, hospital registry | 1531 | 190 (12.4) | None | Outcome better in controls (patients treated with tPA within 3 hours of symptoms) | Baseline ASPECTS similar in WUS and controls within 3 hours of symptoms and treated with tPA |
| Manawadu et al29 | Retrospective, prospectively collected data, hospital registry | 1836 | 193 (10.5) | — | Outcome better in thrombolyzed WUS vs nonthrombolyzed WUS | CT ASPECTS and CTP to select patients for IV tPA |
Abbreviations: WUS, wake-up stroke; RCT, randomized controlled trial; CT, computed tomography; CTP, CT perfusion; MRI, magnetic resonance imaging; DWI, diffusion-weighted imaging; PWI, perfusion-weighted imaging; ASPECTS, Alberta Stroke Program Early CT Score; rNIHSS, retrospective National Institutes of Health Stroke Scale; BP, blood pressure; AF, atrial fibrillation.