ALBERTA STROKE PROGRAM EARLY CT SCORE (ASPECTS) IN PATIENTS WITH

WAKE-UP STROKE

ABSTRACT

One-quarter of ischemic strokes occur during sleep, and affected patients are excluded
from thrombolytic therapy because of an unknown time of stroke onset. It has been
suggested that early ischemic changes detected on computed tomography (CT) are
similar in patients with acute stroke and patients who recently awoke with stroke. We
compared head CT scans using the Alberta Stroke Program Early CT Score
(ASPECTS) in patients who were likely to suffer their stroke during sleep (awoke group)
and a control group of patients with stroke of known onset time. Patients were recruited
from a prospectively collected acute stroke database. The awoke group was defined as
all ischemic stroke patients who were “last seen normal” more than 4 hours ago, arrived
between 4 a.m. and 10 a.m., and underwent head CT within 15 hours of the time last
seen normal. The control group was randomly selected from patients who underwent
head CT within 4 hours of stroke onset. The ASPECTS evaluations were performed by
investigators blinded to patient group and time of onset. A modified Rankin Scale (mRS)
score was available in 15 awoke patients and 46 control patients at 90 days after stroke.
Twenty-eight awoke patients and 68 control patients had suitable imaging for the
ASPECTS. Baseline demographic characteristics and risk factors were similar in the 2
groups. The dichotomized ASPECTS analysis (≤7 vs 8-10) showed no significant
differences between the groups. ASPECTS was 8–10 in 89.3% the awoke group and
95.6% in the control group (P = .353). There was a trend toward higher 90-day mRS
score (0-1) in the awoke group versus controls (73% vs 45%; P = .079). Initial
ASPECTS was similar in patients with wake-up stroke and those with 4 hours of
symptoms. This suggests that a subset of wake-up stroke patients might be suitable for
thrombolytic therapy.

Key Words:
Modified Rankin Scale, acute ischemic stroke, early brain ischemic
change, thrombolysis
FULL TEXT

One-quarter of ischemic strokes occur during sleep, and affected patients are excluded
from thrombolytic therapy because of an unknown time of stroke onset. It has been
suggested that early ischemic changes detected on computed tomography (CT) are
similar in patients with acute stroke and patients who recently awoke with stroke. We
compared head CT scans using the Alberta Stroke Program Early CT Score
(ASPECTS) in patients who were likely to suffer their stroke during sleep (awoke group)
and a control group of patients with stroke of known onset time. Patients were recruited
from a prospectively collected acute stroke database. The awoke group was defined as
all ischemic stroke patients who were “last seen normal” more than 4 hours ago, arrived
between 4 a.m. and 10 a.m., and underwent head CT within 15 hours of the time last
seen normal. The control group was randomly selected from patients who underwent
head CT within 4 hours of stroke onset. The ASPECTS evaluations were performed by
investigators blinded to patient group and time of onset. A modified Rankin Scale (mRS)
score was available in 15 awoke patients and 46 control patients at 90 days after stroke.
Twenty-eight awoke patients and 68 control patients had suitable imaging for the
ASPECTS. Baseline demographic characteristics and risk factors were similar in the 2
groups. The dichotomized ASPECTS analysis (≤7 vs 8-10) showed no significant
differences between the groups. ASPECTS was 8–10 in 89.3% the awoke group and
95.6% in the control group (P = .353). There was a trend toward higher 90-day mRS
score (0-1) in the awoke group versus controls (73% vs 45%; P = .079). Initial
ASPECTS was similar in patients with wake-up stroke and those with 4 hours of
symptoms. This suggests that a subset of wake-up stroke patients might be suitable for
thrombolytic therapy.

Key Words:
Modified Rankin Scale, acute ischemic stroke, early brain ischemic
change, thrombolysis