Daily Variation in the Occurrence of Different Subtypes of Stroke

Abstract

Three thousand two hundred and ninety-eight patients admitted to our Stroke Unit with hemorrhagic, large artery atherosclerosis, cardioembolic, small-vessel occlusion, and undetermined etiology-cryptogenic strokes were included in the study. The circadian variability in onset in each stroke subgroup and the associations with various risk factors were analyzed. In each subgroup, a significant minority of patients suffered from stroke during sleep. In the ischemic group, hypercholesterolemia, paroxysmal atrial fibrillation, and previous myocardial infarction facilitated the onset during waking. During waking, stroke onset was significantly higher in the morning compared to the afternoon both in the hemorrhagic and in the ischemic type. In hemorrhagic stroke, a previous stroke was associated with a lower early morning occurrence. In large artery atherosclerosis stroke, males were at higher risk of early morning occurrence (p < 0.01). In small-vessel occlusion stroke, hypertension is significantly more present in the morning compared to the afternoon onset (p < 0.005). Circadian patterns of stroke onset were observed both in hemorrhagic and in ischemic stroke, irrespective of the ischemic subgroup. In all groups, stroke was more likely to occur during waking than during sleep and, in the diurnal period, during morning than during afternoon. Moreover, sex and some clinical factors influence the diurnal pattern.

The influence of circadian variation in ischemic stroke onset on the evolution of the severity of the clinical picture and disability

“…In the case of the studied group, the circadian variation pattern of ischemic stroke is confirmed, having the highest incidence in the 06.01-12.00 interval and the lowest incidence during the night (00.01-06.00) ( Fig. 1), according to literature data derived from both retrospective (5)(6)(7)(8)14) and prospective studies (15)(16)(17). This pattern is more obvious for patients aged less than 65 years.…”

“…There are very few literature data on the evolution of NIHSS and mRS scores depending on the circadian interval in which stroke has occurred, the available data being derived only from the initial admission of patients with ischemic stroke (values at admission versus discharge), not from evolution during a longer follow-up period. However, the results are concordant, describing the best evolution of the functional score (mRS) from admission to discharge for patients with ischemic stroke onset in the 04.01-08.00 interval and the lowest score in the 20.01-24.00 interval, without statistically significant differences for NIHSS (8,11). The evolution of the mRS score is also consistent with the results of another study performed by us, in which the degree of disability was assessed based on ADL (activities of daily living) and IADL (instrumental activities of daily living) scores, with their least favorable evolution for ischemic stroke occurring in the nocturnal interval 00.01-06.00 and the greatest improvement for all time intervals during the first year after stroke (18).…”

“…The study of the temporal variation in the incidence of cerebrovascular pathology is part of this interest (1)(2)(3)(4). Ischemic stroke describes a circadian variation pattern with the highest incidence in the morning, according to most literature reports (5)(6)(7)(8)(9). The NIHSS Scale (the National Institute of Health Stroke Scale) reflects the severity of the neurological picture, and the mRS disability score (Modified Rankin Score) assesses the degree of functional impairment in post-ischemic stroke patients, both scores representing parameters that allow monitoring patient evolution (10).…”

Adverse influence of bisoprolol on central blood pressure in the upright position: a double-blind placebo-controlled cross-over study

“…To our knowledge, the finding that upright posture accentuates the beta-blockers' deleterious effects on central BP has not been shown before. Of note, the incidence of ischemic stroke is highest during morning hours [38], a moment after waking up and probably after changes in body posture. The hemodynamic alterations in response to the changes in body posture might contribute to this circadian variation and calls for further study in subjects on betablocker therapy.…”

Spontaneous Intracerebral Hemorrhage: Patient’s Activities before the Onset of Stroke and Localization of Intracerebral Hemorrhage in Black Africans

“…ICH also occurred frequently during physical work, while SAH occurred as frequently during mental work or housework as during hard physical labor. In a more recent study (Luciana et al, 2017), authors suggest that the daily occurrence of stroke is significantly influenced by the circadian clock that determines biorhythms, the circadian fluctuations of vital and physiological parameters, and the subjects' activities.…”