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Wim Van Zwam and Daniel Vela-Duarte tackle a controversial but critical issue in acute stroke care: how should we manage wake-up strokes? Current guidelines often delay treatment by requiring advanced imaging, especially when patients are referred from other centers. Yet, for early-window patients, this can cost precious time. With no clinical trials specifically addressing this population, Prof Van Zwam proposes a pragmatic protocol to streamline care and prioritize immediate treatment. The discussion also explores how circadian rhythms may influence the timing and frequency of wake-up strokes.
