WUSED Study: Wake-Up Strokes in the Emergency Department

BACKGROUND: Wake-up stroke (WS) poses a unique challenge to the emergency department (ED) physicians and neurologists in terms of planning optimal therapy, as the time of onset of the episode is unknown. OBJECTIVE: The aim of our study was to profile the WS presenting to the ED and compare the predictors of hemorrhagic versus ischemic types of stroke. MATERIALS AND METHODS: This retrospective study was done in the ED of a large tertiary care hospital in South India from January 2017 to June 2017. The hospital electronic database was accessed for information on patients with WS. RESULTS AND CONCLUSIONS: During the study period, a total of 346 patients presented with a stroke, of which 88 (25.4%) patients had a WS. The mean (SD) age was 59 (13) years, three-fourths (73.9%) were males. Only 68% presented to the ED before noon (12 pm). A tenth (10.2%) had a previous stroke. Examination findings included motor deficit (79.5%), slurring of speech (46%). Magnetic resonance imaging (MRI) was done in 33 patients, and computed tomography (CT) was done in 52 patients. The majority (92%) were anterior circulation strokes, with ischemic strokes (82%) being the commonest. Patients with hemorrhagic strokes had a significantly lower mean age (54.31 vs 60.12 years), a higher mean systolic blood pressure (162.50 vs 143.66 mm Hg), and a higher incidence of hypoxia at ED arrival (18.8% versus 4.1%; P = 0.049).