Hi all!

The wake up stroke MRI is going live! This is based on the WAKE-UP clinical trial in NEJM. This protocol is for patients that present with new symptoms upon waking up with last known well when they went to bed the previous night. This is not for a patient that is a candidate for thrombectomy (ie not an LVO or no occlusion seen on CTA that is amenable to thrombectomy). If your patient fits the above criteria, you would order the WAKE-UP MRI order on Epic (see below for picture). The sequences on MRI are:

Axial DWI
Axial T2 SSFE (fast acquisition of images)
Axial FLAIR
Axial T2* GRE (similar to susceptibility weighted imaging to help with iron deposition and microbleeds)

Of note, MRA is not part of the order set because it is presumed that CTA has already been done. You can order an MRA but it should be done after and is not urgent, IT SHOULD NOT DELAY TPA! If they have diffusion restriction on DWI but no hyperintense correlate on FLAIR, then they are a candidate for thrombolysis, in this case tPA (not TNK since not getting thrombectomy). Hopefully this means that we are able to help more people get the treatments they need. If you have any questions, please feel free to reach out to the chiefs, stroke fellow or stroke attendings.

Your chiefs,

Ruth, Jasmine & Ribal