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Wake‐​Up Stroke: A New Treatment Protocol

Posted on: July 19th, 2016 by Andrew Saluke

Learn about the St. Dominic wake up stroke protocol.

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The need for a standardized wake up stroke protocol

Wake‐​up stroke (WUS) occurs when patients present with stroke symptoms upon awakening. WUS accounts for approximately 25% of acute ischemic strokes and exhibits a key defining and complicating feature: unknown onset time. Due to this unknown onset time, WUS patients are often excluded from consideration of aggressive stroke treatment and are generally treated with routine medical management only.

During the live broadcast, we polled our nationwide audience to determine the prevalence of wake‐​up stroke protocols across the U.S. Seventy‐​eight percent of the audience came from a primary or comprehensive stroke center, and 9% came from an acute stroke ready hospital. Only a small portion of the audience (16%) had a wake up stroke protocol in place.

attendees were asked about their wake up stroke protocols

St. Dominic published and tested a groundbreaking wake up stroke protocol

In an effort to rapidly identify WUS patients who might benefit from endovascular stroke therapies, the team at St. Dominic Comprehensive Stroke Center boldly developed a standardized protocol involving advanced imaging and rapid interpretation. After educating all major stakeholders, St. Dominic published the Wake Up Stroke Protocol in February 2015. The protocol included a one‐​call alert system and pre‐​set orders for advanced diagnostic imaging.

St. Dominic wake up stroke protocol

A ninety‐​day trial period showed the protocol to be effective at identifying WUS patients who were eligible for endovascular therapy. Of the patients treated, the average improvement on the NIHSS was 5.5 points. More than half of the patients treated with interventional stroke therapy improved and were discharged home; more than a quarter improved and were discharged to rehabilitation.

This recorded webinar about the St. Dominic wake up stroke protocol includes discussion of:

  • Diagnostic/​evaluation criteria for WUS patients
  • A detailed patient case study, including clinical images and the patient’s account
  • Advice on educating key stakeholders, including colleagues in neurology, emergency and radiology departments
  • Potential implications for telestroke networks

Who should view the webinar recording:

  • Hospital and health system heads of emergency medicine
  • ED physicians, nurses and internal medicine hospitalists
  • Neurologists, neurosurgeons and interventionalists
  • Telemedicine and telestroke program directors, managers and coordinators


About the Presenters:

Dr. Ruth Fredericks is a neurologist and the Medical Co‐​Director of the St. Dominic Hospital Comprehensive Stroke Center in Jackson, Mississippi.

Dr. Scott McPherson is a neuro‐​interventional radiologist and the Medical Co‐​Director of the St. Dominic Hospital Comprehensive Stroke Center.

Wendy Barrilleaux is the Director of Stroke Services at St. Dominic Hospital. She is the Central District Stroke Coordinator for the Mississippi Healthcare Alliance and serves on the Mississippi Stroke System of Care Advisory Committee.

Bill Alexander is a registered nurse who works in the St. Dominic Neuro ICU. He suffered a wake‐​up stroke in Spring 2016, was evaluated via telemedicine, and was then transferred to St. Dominic. The WUS protocol was activated, and Bill was treated using an endovascular procedure.

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