Abstract 3793: Wake-up Strokes Similar to Known-Onset Morning Strokes in Severity and Outcomes

Abstract

Background: Stroke symptoms first noticed upon waking (wake-up strokes) account for 15-30% of all acute ischemic strokes. Whether or not the onset of ischemic stroke wakes people from sleep is not known. We sought to compare patient demographics, stroke characteristics and outcomes among people with wake-up strokes to those with known-onset morning strokes. Methods: Using retrospective chart review, we identified patients with wake-up strokes (WUS). WUS was defined as asleep for >3 hours and symptoms noted on wakening from 01:00-11:00. We then identified patients with known-onset morning stroke, defined as symptoms noted when patient already awake, during same time interval. We compared WUS to known-onset morning strokes with respect to patient demographics, stroke severity, etiology and outcomes. Results: 112 patients with documented time of 01:00-11:00 when symptoms were first noted were included in the analysis; 33 (29.5%) wake-up strokes and 79 (70.5%) known-onset morning strokes. Patients with WUS were significantly more likely to be female (p=0.009). WUS patients demonstrated a trend toward lower IV tPA treatment rate (p=0.079), higher atherosclerotic burden with greater proportion having carotid artery stenosis (p=0.109), and large vessel mechanism (40.6% vs. 24%). A higher proportion of cortical involvement was also observed among wake-up strokes (p=0.07). Wake-up stroke and known-onset morning strokes were similar with respect to stroke severity (as measured by NIHSS score) at presentation, 24 hours and discharge. WUS was not an independent significant predictor of favorable functional status (mRS 0-2, p=0.371), good disposition (home or inpatient rehab, p=0.909) or mortality (p=0.303). Discussion: While wake-up strokes were similar to known-onset strokes that occurred in the same time interval in stroke severity, functional outcomes, disposition and mortality, WUS patients tended to be older, to be female, and to have large vessel disease. A larger sample size is needed to discern whether large artery atherosclerosis is more likely to cause ischemic stroke while a patient in sleeping and if IV tPA alters the natural history of wake-up strokes.