{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T02:22:11Z","timestamp":1758421331717,"version":"3.44.0"},"reference-count":47,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T00:00:00Z","timestamp":1696118400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T00:00:00Z","timestamp":1696118400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T00:00:00Z","timestamp":1696118400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T00:00:00Z","timestamp":1696118400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T00:00:00Z","timestamp":1696118400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T00:00:00Z","timestamp":1696118400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T00:00:00Z","timestamp":1696118400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["21K07472"],"award-info":[{"award-number":["21K07472"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013170","name":"Ono Pharmaceutical","doi-asserted-by":"publisher","award":["C608-1"],"award-info":[{"award-number":["C608-1"]}],"id":[{"id":"10.13039\/501100013170","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["JP22lk0201094","JP22lk0201109"],"award-info":[{"award-number":["JP22lk0201094","JP22lk0201109"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jns-journal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of the Neurological Sciences"],"published-print":{"date-parts":[[2023,10]]},"DOI":"10.1016\/j.jns.2023.120798","type":"journal-article","created":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T21:58:15Z","timestamp":1694642295000},"page":"120798","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Characteristics and outcomes of unknown onset stroke: The Japan Stroke Data Bank"],"prefix":"10.1016","volume":"453","author":[{"given":"Shinichi","family":"Wada","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sohei","family":"Yoshimura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazunori","family":"Toyoda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michikazu","family":"Nakai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuke","family":"Sasahara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaori","family":"Miwa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junpei","family":"Koge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akiko","family":"Ishigami","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masayuki","family":"Shiozawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuniaki","family":"Ogasawara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takanari","family":"Kitazono","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigeru","family":"Nogawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshitaka","family":"Iwanaga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihiro","family":"Miyamoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuo","family":"Minematsu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masatoshi","family":"Koga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"key":"10.1016\/j.jns.2023.120798_bb0005","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1161\/STROKEAHA.116.014889","article-title":"Intravenous thrombolysis in unknown onset \u2013 stroke: results from the safe implementation of treatment in stroke- international stroke thrombolysis registry","volume":"48","author":"Dorado","year":"2017","journal-title":"Stroke"},{"key":"10.1016\/j.jns.2023.120798_bb0010","doi-asserted-by":"crossref","first-page":"153","DOI":"10.3389\/fneur.2014.00153","article-title":"Wake-up stroke and stroke of unknown onset: a critical review","volume":"5","author":"Wouters","year":"2014","journal-title":"Front. Neurol."},{"key":"10.1016\/j.jns.2023.120798_bb0015","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1177\/1747493017702664","article-title":"Unclear-onset intracerebral hemorrhage: clinical characteristics, hematoma features, and outcomes","volume":"12","author":"Inoue","year":"2017","journal-title":"Int. J. Stroke"},{"key":"10.1016\/j.jns.2023.120798_bb0020","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1111\/ijs.12388","article-title":"Differences in wake-up and unknown onset stroke examined in a stroke registry","volume":"10","author":"Reid","year":"2015","journal-title":"Int. J. Stroke"},{"key":"10.1016\/j.jns.2023.120798_bb0025","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1007\/s00415-006-0438-y","article-title":"Does sleep protect against ischemic stroke? Less frequent ischemic strokes but more severe ones","volume":"254","author":"Jim\u00e9nez-Conde","year":"2007","journal-title":"J. Neurol."},{"key":"10.1016\/j.jns.2023.120798_bb0030","doi-asserted-by":"crossref","first-page":"105842","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.105842","article-title":"Unknown onset stroke: differences between patients with wake-up stroke and daytime-unwitnessed stroke","volume":"30","author":"Vedder","year":"2021","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"10.1016\/j.jns.2023.120798_bb0035","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1159\/000489566","article-title":"Wake-up stroke versus stroke with known onset time: clinical and multimodality CT imaging characteristics","volume":"45","author":"Dankbaar","year":"2018","journal-title":"Cerebrovasc. Dis."},{"key":"10.1016\/j.jns.2023.120798_bb0040","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s00062-022-01188-5","article-title":"Outcome of stroke patients with unknown onset and unknown time last known well undergoing endovascular therapy","volume":"33","author":"St\u00f6sser","year":"2023","journal-title":"Clin. Neuroradiol."},{"key":"10.1016\/j.jns.2023.120798_bb0045","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1212\/WNL.0b013e318219fb30","article-title":"Population-based study of wake-up strokes","volume":"76","author":"Mackey","year":"2011","journal-title":"Neurology"},{"key":"10.1016\/j.jns.2023.120798_bb0050","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1159\/000341242","article-title":"Ischemic stroke on awakening: patients\u2019 characteristics, outcomes and potential for reperfusion therapy","volume":"39","author":"Koton","year":"2012","journal-title":"Neuroepidemiology"},{"key":"10.1016\/j.jns.2023.120798_bb0055","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/j.1747-4949.2012.00779.x","article-title":"Wake-up or unclear-onset strokes: are they waking up to the world of thrombolysis therapy?","volume":"7","author":"Kang","year":"2012","journal-title":"Int. J. Stroke"},{"key":"10.1016\/j.jns.2023.120798_bb0060","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1159\/000278929","article-title":"Wake-up stroke: clinical and neuroimaging characteristics","volume":"29","author":"Silva","year":"2010","journal-title":"Cerebrovasc. Dis."},{"key":"10.1016\/j.jns.2023.120798_bb0065","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1159\/000016005","article-title":"Stroke during sleep: epidemiological and clinical features","volume":"9","author":"Bornstein","year":"1999","journal-title":"Cerebrovasc. Dis."},{"key":"10.1016\/j.jns.2023.120798_bb0070","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1056\/NEJMoa1804355","article-title":"MRI-guided thrombolysis for stroke with unknown time of onset","volume":"379","author":"Thomalla","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"10.1016\/j.jns.2023.120798_bb0075","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1016\/S1474-4422(11)70192-2","article-title":"DWI-FLAIR mismatch for the identification of patients with acute ischaemic stroke within 4.5 h of symptom onset (PRE-FLAIR): a multicentre observational study","volume":"10","author":"Thomalla","year":"2011","journal-title":"Lancet Neurol."},{"key":"10.1016\/j.jns.2023.120798_bb0080","doi-asserted-by":"crossref","first-page":"1574","DOI":"10.1016\/S0140-6736(20)32163-2","article-title":"Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data","volume":"396","author":"Thomalla","year":"2020","journal-title":"Lancet"},{"key":"10.1016\/j.jns.2023.120798_bb0085","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1056\/NEJMoa1813046","article-title":"Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke","volume":"380","author":"Ma","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"10.1016\/j.jns.2023.120798_bb0090","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1161\/STROKEAHA.120.030848","article-title":"Magnetic resonance imaging-guided thrombolysis (0.6 mg\/kg) was beneficial for unknown onset stroke above a certain core size: THAWS RCT substudy","volume":"52","author":"Toyoda","year":"2021","journal-title":"Stroke"},{"key":"10.1016\/j.jns.2023.120798_bb0095","doi-asserted-by":"crossref","first-page":"321","DOI":"10.5853\/jos.2018.01788","article-title":"Consensus guides on stroke thrombolysis for anticoagulated patients from Japan: application to other populations","volume":"20","author":"Toyoda","year":"2018","journal-title":"J. Stroke"},{"key":"10.1016\/j.jns.2023.120798_bb0100","doi-asserted-by":"crossref","first-page":"449","DOI":"10.2176\/nmc.st.2019-0177","article-title":"Guidelines for intravenous thrombolysis (recombinant tissue-type plasminogen activator), the third edition, march 2019: a guideline from the Japan stroke society","volume":"59","author":"Toyoda","year":"2019","journal-title":"Neurol. Med. Chir. (Tokyo)"},{"key":"10.1016\/j.jns.2023.120798_bb0105","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa1706442","article-title":"Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct","volume":"378","author":"Nogueira","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"10.1016\/j.jns.2023.120798_bb0110","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1111\/ene.13580","article-title":"Unknown-onset strokes with anterior circulation occlusion treated by thrombectomy after DWI-FLAIR mismatch selection","volume":"25","author":"Escalard","year":"2018","journal-title":"Eur. J. Neurol."},{"key":"10.1016\/j.jns.2023.120798_bb0115","doi-asserted-by":"crossref","first-page":"163","DOI":"10.2176\/nmc.nmc.st.2020-0357","article-title":"Guidelines for mechanical thrombectomy in Japan, the fourth edition, March 2020: a guideline from the Japan stroke society, the Japan neurosurgical society, and the Japanese society for neuroendovascular therapy","volume":"61","author":"Yamagami","year":"2021","journal-title":"Neurol. Med. Chir. (Tokyo)"},{"key":"10.1016\/j.jns.2023.120798_bb0120","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1001\/jamaneurol.2021.4346","article-title":"Twenty-year change in severity and outcome of ischemic and hemorrhagic strokes","volume":"79","author":"Toyoda","year":"2022","journal-title":"JAMA Neurol."},{"key":"10.1016\/j.jns.2023.120798_bb0125","doi-asserted-by":"crossref","first-page":"e1738","DOI":"10.1212\/WNL.0000000000200153","article-title":"Etiology and outcome of ischemic stroke in patients with renal impairment including chronic kidney disease: Japan Stroke Data Bank","volume":"98","author":"Miwa","year":"2022","journal-title":"Neurology"},{"key":"10.1016\/j.jns.2023.120798_bb0130","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1161\/STROKEAHA.118.024351","article-title":"Effect of edaravone on neurological symptoms in real-world patients with acute ischemic stroke","volume":"50","author":"Kobayashi","year":"2019","journal-title":"Stroke."},{"key":"10.1016\/j.jns.2023.120798_bb0135","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1177\/17474930221090347","article-title":"Committee for stroke guideline 2021, the Japan stroke society, Japan stroke society guideline 2021 for the treatment of stroke","volume":"17","author":"Miyamoto","year":"2022","journal-title":"Int. J. Stroke"},{"key":"10.1016\/j.jns.2023.120798_bb0140","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.114.001119","article-title":"Trial of ORG 10172 in acute stroke treatment (TOAST) classification and vascular territory of ischemic stroke lesions diagnosed by diffusion-weighted imaging","volume":"3","author":"Chung","year":"2014","journal-title":"J. Am. Heart Assoc."},{"key":"10.1016\/j.jns.2023.120798_bb0145","doi-asserted-by":"crossref","first-page":"3563","DOI":"10.3390\/jcm11123563","article-title":"Admission severity of atrial-fibrillation-related acute ischemic stroke in patients under anticoagulation treatment: a systematic review and meta-analysis","volume":"11","author":"Garcia","year":"2022","journal-title":"J. Clin. Med."},{"key":"10.1016\/j.jns.2023.120798_bb0150","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1159\/000441281","article-title":"Chronic kidney disease and functional outcomes 6 months after ischemic stroke: a prospective multicenter study","volume":"46","author":"Jang","year":"2016","journal-title":"Neuroepidemiology"},{"key":"10.1016\/j.jns.2023.120798_bb0155","doi-asserted-by":"crossref","first-page":"11634","DOI":"10.1038\/s41598-021-91257-5","article-title":"Recanalisation theraphy for acute ischemic stroke in cancer patients","volume":"11","author":"Merlino","year":"2021","journal-title":"Sci. Rep."},{"key":"10.1016\/j.jns.2023.120798_bb0160","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1056\/NEJMoa1713973","article-title":"Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging","volume":"378","author":"Albers","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"10.1016\/j.jns.2023.120798_bb0165","first-page":"23","article-title":"Cardioembolic Stroke: risk factors, clinical features, and early outcome in 956 consecutive patients","volume":"73","author":"Gri\u00f1\u00e1n","year":"2020","journal-title":"Rev. Investig. Clin."},{"key":"10.1016\/j.jns.2023.120798_bb0170","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1161\/CIRCRESAHA.120.316340","article-title":"Epidemiology of atrial fibrillation in the 21st century: novel methods and new insights","volume":"127","author":"Kornej","year":"2020","journal-title":"Circ. Res."},{"key":"10.1016\/j.jns.2023.120798_bb0175","article-title":"Impact of onset-to-door time on outcomes and factors associated with late hospital arrival in patients with acute ischemic stroke","volume":"16","author":"Lee","year":"2021","journal-title":"PLoS One"},{"key":"10.1016\/j.jns.2023.120798_bb0180","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1093\/ehjqcco\/qcz063","article-title":"Trends in preadmission oral anticoagulant use and clinical outcome in atrial fibrillation patients admitted with acute stroke in Denmark","volume":"6","author":"Larsen","year":"2020","journal-title":"Eur. Heart J. Qual. Care Clin. Outcomes"},{"key":"10.1016\/j.jns.2023.120798_bb0185","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.genm.2012.10.001","article-title":"Sex and life expectancy","volume":"9","author":"Seifarth","year":"2012","journal-title":"Gend. Med."},{"key":"10.1016\/j.jns.2023.120798_bb0190","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1016\/j.jstrokecerebrovasdis.2012.07.006","article-title":"Effects of sex difference on clinical features of acute ischemic stroke in Japan","volume":"22","author":"Maeda","year":"2013","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"10.1016\/j.jns.2023.120798_bb0195","doi-asserted-by":"crossref","first-page":"113384","DOI":"10.1016\/j.expneurol.2020.113384","article-title":"Sex differences in stroke co-morbidities","volume":"332","author":"Branyan","year":"2020","journal-title":"Exp. Neurol."},{"key":"10.1016\/j.jns.2023.120798_bb0200","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1161\/STROKEAHA.114.006520","article-title":"Impact of living alone on the care and outcomes of patients with acute stroke","volume":"45","author":"Reeves","year":"2014","journal-title":"Stroke"},{"key":"10.1016\/j.jns.2023.120798_bb0205","doi-asserted-by":"crossref","first-page":"150","DOI":"10.2174\/157340310791658730","article-title":"Cardioembolic stroke: clinical features, specific cardiac disorders and prognosis","volume":"6","author":"Arboix","year":"2010","journal-title":"Curr. Cardiol. Rev."},{"key":"10.1016\/j.jns.2023.120798_bb0210","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1161\/CIRCULATIONAHA.109.892497","article-title":"Age-related differences in characteristics, performance measures, treatment trends, and outcomes in patients with ischemic stroke","volume":"121","author":"Fonarow","year":"2010","journal-title":"Circulation"},{"key":"10.1016\/j.jns.2023.120798_bb0215","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.18632\/aging.100997","article-title":"Stroke sensitivity in the aged: sex chromosome complement vs. gonadal hormones","volume":"8","author":"McCullough","year":"2016","journal-title":"Aging (Albany NY)"},{"key":"10.1016\/j.jns.2023.120798_bb0220","article-title":"Trends in in-hospital mortality among patients with stroke in China","volume":"9","author":"He","year":"2014","journal-title":"PLoS One"},{"key":"10.1016\/j.jns.2023.120798_bb0225","doi-asserted-by":"crossref","first-page":"2332","DOI":"10.1161\/STROKEAHA.115.009688","article-title":"Ischemic stroke tissue-window in the new era of endovascular treatment","volume":"46","author":"Hill","year":"2015","journal-title":"Stroke"},{"key":"10.1016\/j.jns.2023.120798_bb0230","first-page":"1343","article-title":"False-negative diffusion-weighted MR findings in acute ischemic stroke","volume":"21","author":"Oppenheim","year":"2000","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"10.1016\/j.jns.2023.120798_bb0235","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1517\/17425250902873796","article-title":"Toxicity of MRI and CT contrasts agents","volume":"5","author":"Hasebroock","year":"2009","journal-title":"Expert Opin. Drug Metab. Toxicol."}],"container-title":["Journal of the Neurological Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0022510X23002599?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0022510X23002599?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T16:03:17Z","timestamp":1758384197000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0022510X23002599"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10]]},"references-count":47,"alternative-id":["S0022510X23002599"],"URL":"https:\/\/doi.org\/10.1016\/j.jns.2023.120798","relation":{},"ISSN":["0022-510X"],"issn-type":[{"type":"print","value":"0022-510X"}],"subject":[],"published":{"date-parts":[[2023,10]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Characteristics and outcomes of unknown onset stroke: The Japan Stroke Data Bank","name":"articletitle","label":"Article Title"},{"value":"Journal of the Neurological Sciences","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jns.2023.120798","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2023 Published by Elsevier B.V.","name":"copyright","label":"Copyright"}],"article-number":"120798"}}