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Using MRI diffusion\/FLAIR (fluid-attenuated inversion recovery) mismatch, it is possible to identify patients within 4.5 hours from onset and safely deliver thrombolysis. Using CT perfusion imaging, it is possible to identify subjects with a middle cerebral artery syndrome who have an extensive area of ischaemic brain but as yet have only a small area of infarction who may benefit from urgent thrombectomy in up to 24 hours. Here, we highlight the recent advances in late window stroke treatment and their potential contribution to clinical practice.<\/jats:p>","DOI":"10.1136\/practneurol-2018-002179","type":"journal-article","created":{"date-parts":[[2019,3,14]],"date-time":"2019-03-14T17:15:24Z","timestamp":1552583724000},"page":"326-331","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Management of a wake-up stroke"],"prefix":"10.1136","volume":"19","author":[{"given":"Xuya","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Neurology, St. George\"s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1661-4280","authenticated-orcid":false,"given":"Vafa","family":"Alakbarzade","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. George\"s University Hospitals NHS Foundation Trust, London, UK"},{"name":"Royal Cornwall Hospitals NHS Trust, Truro, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nader","family":"Khandanpour","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. George\"s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony C","family":"Pereira","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. George\"s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,3,14]]},"reference":[{"key":"2025090409201986000_19.4.326.1","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1016\/S0140-6736(15)60715-2","article-title":"Thrombolysis in acute stroke","volume":"385","author":"Brunstr\u00f6m","year":"2015","journal-title":"The Lancet"},{"key":"2025090409201986000_19.4.326.2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(16)30076-X"},{"key":"2025090409201986000_19.4.326.3","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.609693"},{"key":"2025090409201986000_19.4.326.4","unstructured":"Sims JR , Rordorf G , Smith EE , et al . 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