PMC6428745_01
Time course of the reported case. (A) shows the actual course, (B) shows the hypothetical course in case of awaiting laboratory and imaging results. All above the number of day is stated, relative to day 0 as admission day, followed by exact time in the second row. Time of last seen well (LSN) was reported for the eve of (day -1. 22:00). First wake up (1.WU) with neurological deficit was reported for 4:00, second wake up (2.WU) for 6:30. The patient was admitted (Adm.) at 7:00 and clinically examined. In parallel a first blood sample was taken (bs1), followed by the administration of idarucizumab (PB), cerebral imaging (MRI), a second blood sample (bs2), and intravenous thrombolysis (rtPA). Analyses of the blood samples took 25-30min, so results for Thrombin time (TT1 and TT2, respectively) were available after this time. Exemplary slices of the diffusion weighted imaging (left) and fluid-attenuated inversion recovery (middle) sequences at admission as well as the control CT at day 1 (right) are shown in the last row of (A). By comparing the actual starting point of intravenous thrombolysis (7:50) with the hypothetical one (8:40), where idarucizumab is applied after receiving the results of the first blood sample and after cerebral imaging, the reduction of the door-to-needle time is comprehensible.
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F1
At 6:30 a.m. he had woken up again with right-sided hemiparesis and dysarthria, whereupon the emergency medical services had been called (see Figure 1 for a graphical presentation of the time course). MRI (according to the house-intern standard operating procedure, and with respect to the WAKE-UP trial. MRI-DWI sequences revealed an acute ischemia in the area of the left anterior choroidal artery without correspondent hyperintensity on the FLAIR-sequences (see Figure 1). Follow up CT on the next day revealed a small demarcated ischemia in the corona radiata (see Figure 1), corresponding to the aforementioned diffusion-restricted area, without intracranial hemorrhage.