We performed a meta-analysis of the diagnostic accuracy of the diffusion-FLAIR mismatch in identifying stroke within 3 and 4.5 h. We looked at the safety and efficacy of thrombolysis and interventional techniques in the group of patients with unknown stroke-onset. In this review, we assessed the current literature about the hypothesis that wake-up-strokes occur just prior on awakening and if this subgroup differs in characteristics compared to the overall stroke population. A large group of these patients might be eligible for therapy. Currently, this subset of patients is excluded from revascularization-therapy since no exact time of onset is known. Patients, who wake up with an ischemic stroke, account for a large number of the total stroke population, due to circadian morning predominance of stroke.
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