Wake-up stroke primarily occurs when patients experience sudden weakness in the face of sleep arousal. Wake up stroke seems to occur because of acute brain dysfunction rather than the typical chronic ischemic process.
In a recent study, findings of this study suggest that wake-up stroke is rare and tends to be recurrent. In an attempt to ascertain whether this is related to the type of stroke, only one patient had a wake-up event. Further work is required to ascertain whether a different stroke subtype may be amenable to treatment with recombinant tissue and/or tissue-derived therapies.
The signs of wake-up stroke are very many. The key symptoms are sudden onset of weakness or numbness or difficulty for speech, confusion, diplopia, and dysphagia. The symptoms may be more or less severe depending on the specific cause. Stroke patients with acute symptoms should be treated quickly and aggressively. Patients with subacute symptoms also can be identified efficiently and treated accordingly.
Patients with WUS are usually treated with aspirin and/or clopidogrel, antiplatelet medication. The choice of antithrombotic agents varies. Patients with recurrent strokes are given medications for prophylaxis against cardiovascular events. Patients who had a stroke in the past usually receive prophylactic antibiotics to decrease the risk of infective endocarditis. Anticoagulants and antiplatelet drugs are usually given to patients who have had a prior thromboembolic event.
WUOS is an abrupt onset of neurological deficits due to a focal neurological deficit that occurs at a later stage compared with a lacunar type of acute ischemic stroke. This type of stroke progresses more rapidly than a lacunar stroke due to the different pathophysiological causes.
The number of people getting stroke when sleeping at home is greater than the number getting stroke in sleeping cars, in hotel beds, or in vehicles. When a person spends a significant portion of their sleep time awake, the risk of having a wake-up stroke is greater. To reduce the number of strokes, not only should people sleep in real bed-sites, but also sleeping vehicles should be sleeping in the real bed-sites and sleeping vehicles should not sleep in the real bed-sites.
Wake-up stroke is diagnosed in more than 30% of patients every year. Wake-up stroke has an enormous impact on both patient and family. In the absence of effective treatments and the lack of evidence-based guidelines, management of these patients is often based on individual medical and ethical considerations. Therefore, new management strategies are being developed in order to optimize and to decrease their impact both in terms of quality of life and health care expenditure.
This pilot study found that patients with non-modifiable risk factors are more likely to have a DWI result which is potentially a 'predictor' for clinical trials. We propose clinical trial targeting for patients with non-modifiable factors (e.g. hypertension, hyperlipidemic heart disease, and age > 71). Data from a recent study of this study have implications for improving patient recruitment for clinical trials. This trial was registered at www.clinicaltrials.gov as NCT02240728.
A greater percentage of patients with acute stroke who woke up and had a first-ever stroke attributed it to ischemic vs. hemorrhagic components of their stroke; however, ischemic stroke is the main cause of awake wake-up strokes.
Evidence-based guidelines do not advise routine use of oxygen in people with mild-to-moderate acute stroke presenting within four hours of symptom onset, regardless of race, age, or stroke severity. The evidence available does not support oxygen therapy in people with mild-to-moderate acute stroke presenting to the emergency department within four hours of symptom onset for the purpose of improving long-term functional outcome and mortality.
In general, oxygen therapy is safe and effective to stop symptoms and brain damage [Oxygen (oxygen) therapy (a breathing treatment) is useful for the treatment of acute hypoxia, a state of insufficient oxygen in the blood (overt hypoxia))]. There are two types of oxygen therapy: mechanical ventilation (breathing oxygen by machine powered by a compressible medium such as air or helium) or high flow, low pressure oxygen delivered to the lungs via a nasal cannula (for example during CPAP (continuous positive airway pressure)) (breathing oxygen administered directly into the lungs) or BIPAP (bi-level positive airway pressure).
Wake-up stroke is a challenging problem for stroke management but it is also potentially life-threatening. Awareness of signs and symptoms prior to wake-up stroke could play an important role in saving lives. A stroke survivor who suffers a seizure or transient weakness and recovers full function within 6 hr needs to be re-assessed accordingly. Further investigation is warranted to understand why wake-up stroke resolves to full function but may become permanent even with early identification of risk factors and treatment options.