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Prevalence of wake-up strokes found in large population
Mackey J. Neurology. 2011;76:1662–1667.
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Almost 15% of all strokes that occurred in a recent study were found to be wake-up strokes. This study, according to researchers, was the first large and population-based study to examine the event rate of wake-up strokes.
Jason Mackey, MD, and fellow colleagues studied all first-time and recurrent ischemic strokes among 1.3 million residents of the Cincinnati/northern Kentucky region in 2005. Only patients aged at least 18 years who were evaluated in an ED were included in the analysis.
Overall, 1,778 residents were identified with 1,854 first-ever and recurrent ischemic strokes. Of these, 273 (14.3%) were wake-up strokes, resulting in an adjusted wake-up stroke event rate of 26 per 100,000 people. Among those who experienced a wake-up stroke, at least 35.9% would have been eligible for thrombolysis had arrival time not been a factor.
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Additional analysis also revealed that those who had wake-up strokes tended to be older (72.3 ± 0.83 years vs. 70 ± 0.48 years; P=.01) and had a higher baseline retrospective NIH Stroke Scale score (median interquartile ratio,4 vs. 3; P=.004).
Despite these factors, study researchers said there were no obvious features distinguishing between wake-up and nonwake-up strokes.
In addition, they said: “Wake-up strokes constitute a significant percentage of ischemic strokes and are ineligible for thrombolytic therapy due to the current time-based restrictions, which is unfortunate because it is likely that some of these events occurred immediately prior to awakening. Efforts are ongoing to develop better methods of identifying those patients most likely to benefit from treatment while at the same time minimizing exposure to undue risk.”
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