Beware of wake-up stroke

I personally think the solution to this problem is magnetic delivery of microbeads of tPA directly to the location of the clot. A much smaller bolus would be needed reducing the side effects of bleeding elsewhere. But since we have NO stroke leadership or strategy this will take decades to come about.
Will no one think of the stroke survivors and actually do something to help them?
This solution maybe from May, 2016.

Stroke victims' new saviour...magnetic blood: Pioneering research could transform treatment of killer condition 

Or maybe this solution from March, 2015

Magnetic nanoparticles could stop blood clot-caused strokes

 

Beware of wake-up stroke 

Thomas (50) (name changed) remembers the panic he felt that morning when he woke up and discovered that something was seriously wrong.

He could not move from the bed because the entire right side of his body was weak. He tried to wake up his wife by calling her but all he could manage was some garbled words.

It was after 8 a.m., when he was rushed to the emergency wing of Sree Chitra Tirunal Institute for Medical Sciences and Technology, where he was immediately rushed in for MRI imaging studies.

“He had presented with what is known as the “wake-up stroke,” wherein a patient awakens with symptoms of a stroke which were not there when he fell asleep.

Imaging studies showed that the brain had suffered only minimal damage and that there was a huge salvageable brain area.

There was a major clot in the main cerebral artery, which we removed using mechanical thrombectomy (removing clot using a device called Solitaire).

He made good recovery and walked out of the hospital,” says P.N. Sylaja, Professor of Neurology, SCTIMST. Approximately 25 per cent of ischemic strokes (strokes which are caused by a blood clot in the brain arteries) are wake-up strokes, wherein patients who go to sleep normally, wake up with stroke symptoms

Intravenous thrombolysis using a recombinant tissue plasminogen activator (rtPA) or clot-busting drug can improve the clinical outcomes of patients with acute ischemic stroke if it is administered within the first 4.5 hours of the stroke onset

The time of the onset of stroke is the key factor on which safe therapeutic decisions are based. Wake-up strokes present a therapeutic dilemma for neurologists because the time of the onset of stroke is unknown. Many patients with wake-up strokes thus suffer from poor outcomes because they are not taken to be candidates for tPA as it can only be delivered within the specified time window.

Delay in treatment has always been a problem in wake-up strokes because often the family might be late in discovering that the person has suffered a stroke and there might be multiple reasons for delays in reaching the hospital too.

“Many recent studies on wake-up strokes however show that most of these strokes actually happen in the morning hours and that the stroke itself may be what woke them up.

So these days, such patients are subjected to advanced CT/MRI Perfusion studies, which can tell us how much of the brain has suffered irreversible damage and how much can be salvaged and if thrombolysis can help him,” Dr. Sylaja says.

Perfusion studies can clearly indicate if significant time delay has occurred after the onset of stroke nad if the patient will benefit from thrombolysis

Wake-up strokes are currently an important area of discussion with large randomised controlled clinical trials happening world over on how best to treat wake-up strokes and the efficacy of IV thrombolysis and endovascular mechanical thrombectomy options.

The patho physiology of wake-up strokes phenomenon is not fully understood and is linked to a combination of bodily changes in the circadian cycle, such as adrenalin secretion, platelet aggregation (leading to clots) or the normal surge in one’s blood pressure, all seen in the early morning hours.

Reporting by

C. Maya

Time of the onset of stroke is the key factor on which safe therapeutic decisions are based