Stuttering Stroke–Last Known Well Time
Stroke symptoms indicate focal brain ischemia, which is inadequate blood supply that can lead to permanent cell death from infarction. When indicated, tPA is administered to attempt to restore blood supply to ischemic brain tissue which has not been permanently injured (died). With a stuttering stroke, every time stroke symptoms resolve, it proves that the brain tissue at issue is still alive and functioning. In other words, this simple and clear clinical evidence establishes that the affected brain tissue is intact and still salvageable and, critically, that the symptoms could return permanently.
The resolution of symptoms provides a new/renewed “last known well time” from which tPA is to be administered to prevent permanent damage. There is no exception for stuttering lacunar stroke versus other ischemic strokes in any of the relevant FDA guidelines, tPA package insert, or medical literature.