Summary

“Wake-up” strokes occur when an individual wakes up with neurological deficits from a stroke. The most frequent time of onset for all subgroups of ischemic stroke is between 6 am and 12 pm [Marsh EE et al. Arch Neurol 1990]. Retrospective studies have shown that wake-up stroke is common, with a prevalence of approximately 14% to 28%. Although tissue plasminogen activator (tPA) significantly improves outcomes [Hacke W et al. N Engl J Med 2008], patients with wake-up stroke are often not eligible for this therapy because the medication must be given within 4.5 hours of when the patient was last known to be normal. This article discusses the epidemiology, clinical features, and available data for the effectiveness of thrombolytic treatment in patients with wake-up stroke.