What is Emergency Medicine -What about a patient who awakens with signs of a stroke?
About 20% of patients who report with stroke either have an uncertain last normal or wake up with a neurologic disability, which puts them beyond the thrombolytic window and disqualifies them for tPA. However, over the past few years, a number of studies have attempted to compare the area of the infarct and the area of dead tissue using two different MRI modalities (DWI and FLAIR), in an effort to identify which patients may have salvageable tissue and benefit from IV thrombolytics regardless of when they last experienced normalcy. This patient cohort was randomly assigned to either tPA or standard care in the WAKE-UP trial, which had improved functional results but was underpowered and had an increase in ICH in the tPA group. However, rather than utilizing the time of the last known normal, selecting thrombolytic candidates may be done in the future using sophisticated imaging modalities.
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