Date of Award


Document Type


Degree Name

Doctor of Medical Science (DMSc)


Department of Physician Assistant Medicine

First Advisor

Kennedy Emerson, PA-S

Second Advisor

Justin M. Gambini, DMSc, PA-C, DFAAPA


Strokes are the leading cause of permanent disability and the second leading singular cause of death in more developed countries.3 Over 13 million individuals worldwide suffer strokes annually, 1 with the vast majority of these being from an ischemic event. Out of these, 20-25% actually occur in individuals who wake up with stroke symptoms, which historically has been considered outside of the time window for treatment.2,3 Previous guidelines indicate that in patients with acute ischemic strokes IV thrombolytic therapy should be administered within 4.5 hours for symptom onset, and is not recommended in patients with an unknown time of symptom onset, including patients who wake up with stroke symptoms.2 Advancements in magnetic resonance imaging (MRI), specifically diffusion weighted imaging (DWI)/fluid attenuated inversion recovery (FLAIR), have been shown to help determine acuity of strokes specifically in patients that wake up with stroke symptoms, to see if there is any salvageable tissues.3 New studies are pushing for the concept of using a “tissue clock” rather than time clock to determine if IV thrombolytics are indicated in acute stroke patients.2 With this imaging capability, more patients have the potential to be treated with IV thrombolytic therapy. Therefore understanding Emerging Evidence for Diagnosis and Treatment of Wake Up Stroke Patients 4 the efficacy and safety of treating this previously excluded patient population, as well as understanding the practicality of implementing emergent MRI guidelines, is crucial in order to provide better patient care.