Reperfusjonsbehandling ved ukjent slagdebut

Thrombolysis and thrombectomy, also called reperfusion therapies, are effective for treating acute ischaemic stroke. The therapy reduces the risk of permanent neurological deficit, and there is a greater chance that patients will not be dependent on assistance afterwards (1, 2). However, it is time-dependent. The shorter the time from symptom onset to treatment start, the greater the chances of a good result. The proportion of ischaemic stroke patients in Norway who receive thrombolysis is only 15 % (3). The main reasons for this treatment not being administered are delayed hospitalisation and unknown time of onset (4, 5). Unknown time of stroke onset may be due either to the patient being alone and incapable of stating when the stroke occurred or to the patient waking with the symptoms. Most strokes with known onset occur in the morning (6). If the majority of strokes during sleep also occur in the morning just before the patient wakes up, this would mean that many patients who do not receive thrombolysis at present, might benefit from doing so. In the cases of patients who wake up with stroke symptoms (WUS) and have a CT scan within three hours of waking up, there are seldom early infarction changes on the CT images. In observation studies of WUS patients, the effectiveness of thrombolysis as reflected in a normal standard CT has been the same as in known onset patients (7).