Stroke Etiology Is Associated with Symptom Onset During Sleep

Spengos, Konstantinos; Tsivgoulis, Georgios; Synetou, Margarita; Vassilopoulou, Sofia; Zakopoulos, Nikos; Vassilopoulos, D.; Vemmos, Konstantinos

doi:10.1093/sleep/28.2.233

Cited by 23 publications

(20 citation statements)

References 49 publications

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“…This is possibly related to the fact that such patients were not alert and were unable to express details of their stroke onset. The reason why this is not the case for sleeponset stroke may be that such strokes are more frequently lacunar [22]. Severe strokes were more frequent in patients with lower hemoglobin levels, suggesting that decreased oxygen transport capacity may increase infarct size, consistent with a previous report [23].…”

Section: Discussionsupporting

confidence: 85%

Severe stroke: patient profile and predictors of favorable outcome

Bill

Zufferey

Faouzi

et al. 2013

Journal of Thrombosis and Haemostasis

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Summary. Background: Severe stroke carries high rates of mortality and morbidity. The aims of this study were to determine the characteristics of patients who initially presented with severe ischemic stroke, and to identify acute and subacute predictors of favorable clinical outcome in these patients. Methods: An observational cohort study, Acute Stroke Registry and Analysis of Lausanne (ASTRAL), was analyzed, and all patients presenting with severe strokedefined as a National Institute of Health Stroke Scale score of ‡ 20 on admission -were compared with all other patients. In a multivariate analysis, associations with demographic, clinical, pathophysiologic, metabolic and neuroimaging factors were determined. Furthermore, we analyzed predictors of favorable outcome (modified Rankin scale score of £ 3 at 3 months) in the subgroup of severe stroke patients. Results: Of 1915 consecutive patients, 243 (12.7%) presented with severe stroke. This was significantly associated with cardio-embolic stroke mechanism (odds ratio [OR] 1.74, 95% confidence interval [CI] 1.19-2.54), unknown stroke onset (OR 2.35, 95% CI 1.14-4.83), more neuroimaging signs of early ischemia (mostly computed tomography; OR 2.65, 95% CI 1.79-3.92), arterial occlusions on acute imaging (OR 27.01, 95% CI 11.5-62.9), fewer chronic radiologic infarcts (OR 0.43, 95% CI 0.26-0.72), lower hemoglobin concentration (OR 0.97, 95% CI 0.96-0.99), and higher white cell count (OR 1.05, 95% CI 1.00-1.11). In the 68 (28%) patients with favorable outcomes despite presenting with severe stroke, this was predicted by lower age (OR 0.94, 95% CI 0.92-0.97), preceding cerebrovascular events (OR 3.00, 95% CI 1.01-8.97), hypolipemic pretreatment (OR 3.82, 95% CI 1.34-10.90), lower acute temperature (OR 0.43,, lower subacute glucose concentration (OR 0.74,, and spontaneous or treatment-induced recanalization (OR 4.51, 95% CI 1.96-10.41). Conclusions: Severe stroke presentation is predicted by multiple clinical, radiologic and metabolic variables, several of which are modifiable. Predictors in the 28% of patients with favorable outcome despite presenting with severe stroke include hypolipemic pretreatment, lower acute temperature, lower glucose levels at 24 h, and arterial recanalization.

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Section: Discussionsupporting

confidence: 85%

Severe stroke: patient profile and predictors of favorable outcome

Bill

Zufferey

Faouzi

et al. 2013

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

show abstract

“…In a prospective study, 18% of patients with stroke of undetermined cause experienced symptoms during sleep which is consistent with our study. However the presence of PFO was not identified in that study [28]. The association of PFO and cerebrovascular events on awakening may be explained by several mechanisms.…”

Section: Symptoms and Clinical Features Of Pfo-associated Cerebrovascmentioning

confidence: 54%

Cryptogenic stroke and patent foramen ovale: Clinical clues to paradoxical embolism

Özdemi̇r

Tamayo

Munoz

et al. 2008

Journal of the Neurological Sciences

108

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“…BP is lower during the night and also falls following sexual intercourse. Interestingly, lacunar strokes, i.e., strokes involving small arterioles similar to those involved in NAION, occur substantially more often during sleep than during waking and this was the only stroke subtype in which this association was seen in that study [67]. Hayreh found that 73% of his 871 eyes with NAION occurred during sleep [68] and has proposed that nocturnal hypotension is a major but underappreciated precipitating risk factor for NAION [69].…”

Section: 3mentioning

confidence: 74%