What is a Wake-up Stroke?

As a woman of faith, Darrhonda Scott-Jones, age 54, describes her stroke as a “lifesaver.”

“I am very thankful that I had a stroke,” said Darrhonda. “The stroke brought my attention to another medical condition I had that I was completely unaware of. I like to think the stroke was God’s way of alerting me to another medical issue.”

Her Wake-up Stroke
God’s wake-up call to Darrhonda was on Feb. 11, 2024. When she woke up to get ready for work, her vision wasn’t clear, so she sat down. When she stood up, her vision still wasn’t clear, and she could tell that one eye was worse than the other.

“As I sat down again, I started to fall over, and I could hear that my voice sounded funny. I woke up my son, and he said my face looked weird,” she said.

At that point, Darrhonda asked her son to drive her to Trinity Health Grand Rapids Emergency Department because she trusts Trinity Health with all of her medical care. She was convinced that something was wrong with her vision.

Darrhonda didn’t know it at the time, but she was having a “wake-up stroke.” Wake-up strokes are strokes with unknown exact time of onset as they are noted on awakening by the patient. They represent 20% of all ischemic strokes.

Diagnosis of Stroke
When Darrhonda explained to the clinical team in the E.D. what had happened, they rushed her to a room for an MRI (magnetic resonance imaging). Because she is claustrophobic, they gave her relaxation medication.

When she woke up, Darrhonda was in a hospital room where Trinity Health Medical Group Neurologist Christopher Goshgarian, MD, told her that she had experienced a wake-up stroke. He explained that he wanted to conduct more tests to help determine the cause of the stroke. One theory is that if a person’s blood pressure drops acutely while sleeping, there can be a lack of enough blood reaching a part of the brain.

“In Ms. Scott-Jones’ case, I believe the underlying cause of her stroke is small vessel disease, which is a common cause,” said Dr. Goshgarian. “It is the hardening of the microscopic penetrating vessels deep in the brain.”

Darrhonda stayed four days in the hospital. “The staff did a wonderful job. The care was very good.”

The Wake-up Stroke Protocol
“Ms. Scott-Jones presented with left-side weakness and was treated with Tenecteplase, which is a modified form of tPA that is used as a thrombolytic agent to dissolve blood clots,” said Dr. Goshgarian. “Her stroke was small, but I suspect she would have had a larger stroke if she had not been treated with Tenecteplase.”

Typically, to administer thrombolytic medications for a stroke, they must be given within four and a half hours of “last known well,” meaning the last time the patient felt well without symptoms.

When a patient has a stroke while sleeping and awakens with symptoms, there is no way to know when the patient was “last well,” and if the stroke occurred within four and a half hours of seeking care.

The Wake-up Stroke Protocol is the result of a study conducted in 2018 that used MRI images of stroke patients to help determine the timing of the stroke. Two MRI sequences are used for this purpose:

1.    DWI (diffusion weighted imaging) is a sequence using an MRI to help to gauge the timing of the stroke. Results are available within a few minutes of completing the image.
2.    FLAIR is a sequence using an MRI that takes four to six hours for results that help gauge when the stroke occurred.

“By completing these two sequences upon arrival at a stroke certified hospital that uses this protocol, the timing of the stroke can be inferred. In this case, Ms. Scott-Jones was able to receive the thrombolytic medication because her stroke fell within the four and a half hour ‘window,’” said Dr. Goshgarian.

In West Michigan, Trinity Health Grand Rapids and Trinity Health Muskegon both use the Wake-up Stroke Protocol.

The Emergency team is able to rely on this protocol because of their excellent relationship with the hospital’s Radiology department.

“Trinity Health Grand Rapids is a Comprehensive Stroke Center. Typically, MRIs are not done acutely, but our Radiology department stops everything and takes our patients immediately in order to use this protocol,” said Dr. Goshgarian.

Darrhonda’s Outcomes
“The results of our treatment have been excellent. Her prognosis is outstanding. Most people would not even know she had a stroke,” said Dr. Goshgarian.

“When a patient presents in the E.D. with an acute stroke, we always get a CT angiogram (CTA) — a vascular study of the head and neck. It was that scan that showed another medical condition that Darrhonda was unaware of. Without the CTA, it would have been missed,” added Dr. Goshgarian.

Lifestyle Changes and Follow-up Care
“I’m careful. I watch my fluid and sugar intake, and I watch my diet closely,” said Darrhonda.

Exercising regularly is more difficult for her. Prior to her stroke, Darrhonda was scheduled to have a total knee replacement, but it had to be postponed twice due to other medical issues. She also has a degenerative disc in her back, which limits her flexibility. However, Darrhonda participates in physical therapy to keep herself moving.

“After the stroke, I met with neurology and did some more testing. Everything came back good. I still have some trouble staying focused, but there is no need for follow-up care unless I feel I need it,” she shared.

Advice for Healthy Living
“I definitely recommend Trinity Health for medical care, and I have mentioned it to others,” said Darrhonda. “I encourage people to listen to their bodies and to attend their well visits with their primary care physicians.  At a certain age, it is even more important to have regular check-ins with our physicians, exercise, and watch our diets.”

Dr. Goshgarian offers this advice: “The most important thing to remember is if you are experiencing stroke symptoms, timing matters. Strokes are a medical emergency. Think of a stroke as a brain attack. Treat it as you would a heart attack — seek immediate medical care. The earlier you can get care and restore blood flow to the brain, the greater opportunity for better outcome.”

Watch this video to learn more about what happens to the brain during a stroke: Time is Brain: The Timeline of a Stroke.
Find out if you're at a higher risk for stroke by taking our quick Health Risk Assessment.