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Implementation of a wake-up and unknown symptom onset stroke protocol

Background: Establishing a symptom onset timeline for stroke patients is one of the essential aspects of thrombolytic therapy. Implementing an MRI protocol can potentially increase the rate of thrombolytic therapy and expand treatment to patients who would otherwise be excluded.Objective: This project aimed to increase the rate of thrombolytic therapy by incorporating an additional layer of evaluation within the established acute stroke code process for patients with wake-up stroke (WUS) or unknown symptom onset stroke.Methods: Patients 18 years of age and older who presented as WUS eligible for thrombolytic therapy underwent acute MRI. Patients with a diffusion weighted image and fluid attenuated inversion recovery mismatch (DWI-FLAIR Mismatch) on MRI were treated with thrombolytic therapy.Results: Chi-square test of independence showed patients who underwent the MRI protocol (N = 35) had a higher proportion of alteplase (tissue plasminogen activator,tPA) treatment when compared to a similar sample (N = 44) from 2019 acute stoke logs; ꭓ2 (1, N = 79) = 8.16, p = .006. Six patients received thrombolytic. Safety showed no symptomatic intracerebral hemorrhage (sICH) or deaths.