◷  Stroke TimelineClinician educational prototype · v1.1
Wake-up stroke / trial timing

Two clocks. One clear timeline.

Calculate time since the midpoint of sleep and symptom recognition. Compare both independently with the EXTEND and WAKE-UP trial timing windows.

Timing is only one part of assessment. These results do not determine thrombolysis eligibility. Imaging selection, contraindications, other trial criteria, and current local protocols require separate clinical review. Both trials studied alteplase.

Enter the timeline

Enter hospital clock dates and times manually. Use explicit dates for overnight intervals. Leave an unknown time blank; that comparison will remain unavailable.

Use the last-known-well time before sleep for the trial-style midpoint estimate. If actual sleep onset differs, confirm the appropriate anchor; do not assume they are identical.
When symptoms were first recognized—not an assumed stroke-onset time.
Windows refer to treatment initiation. This time is a fixed snapshot, not a live countdown.
Daylight-saving clock change

Hospital clock times only. No device clock or automatic timezone conversion is used.

Perfusion-selected trial

EXTEND

Awaiting times
Time since sleep midpoint
—

Time window: ≤9 hours from estimated sleep midpoint for wake-up stroke.

Imaging required: CT/MR perfusion mismatch with ischemic core <70 mL, hypoperfused-to-core volume ratio >1.2, and mismatch volume >10 mL. All three required. Timing alone does not establish trial eligibility.

MRI-selected trial

WAKE-UP

Awaiting times
Time since symptom recognition
—

Time window: ≤4.5 hours from recognition in unknown-onset stroke.

Imaging required: Acute ischemic lesion on MRI DWI without corresponding marked parenchymal FLAIR hyperintensity. Other trial criteria also apply.

Sleep midpoint

—
Beginning of interval + half the actual elapsed sleep interval; adjusted for a declared clock change.
Sleep interval begins—
Awakening—
Comparison time—

Documentation summary

Trial references & interpretation
  1. EXTEND — Ma et al. NEJM, 2019. Wake-up stroke timing uses the estimated midpoint of sleep; the trial also included a separate known-onset 4.5–9-hour pathway, which is not calculated here.
  2. WAKE-UP — Thomalla et al. NEJM, 2018. Unknown-onset stroke with MRI selection. Trial registry specifies treatment within 4.5 hours of symptom recognition.

All entries must refer to the same hospital clock. Clock changes must be declared manually; no timezone is inferred. Both windows are compared independently; meeting one does not require meeting the other. Exactly at a boundary is shown separately and leaves no time margin. Being outside these trial timing windows does not rule out other reperfusion pathways. This is a timing reference, not a complete trial enrollment checklist or current guideline eligibility engine.