Cerebral infarction does not occur typically at night.

Abstract

SUMMARY In a hospital-based series of 66 consecutive patients with non-progressive cerebral infarction, the time of onset and the type of infarction on computed tomography were studied retrospectively. Forty-six (78%) patients suffered cerebral infarction between 6am and 6pm. Only five patients (8%) had their infarct between midnight and 6am. Only three patients had a watershed-infarct, and these occurred during the daytime. Our results do not support the belief that atherothrombotic brain infarction is largely determined by haemodynamic factors.Traditional teaching holds that cerebral infarction occurs more often at night than during the daytime and that symptoms are usually noticed on waking. This, in combination with the fact that blood pressure is lower during the night, fits the notion of cerebral "thrombosis". However, the evidence that cerebral infarction is a nocturnal illness1'2 is not convincing.In those studies, the diagnosis of cerebral infarction was imprecisely defined, or more importantly, patients with incomplete information have not been taken into account. To shed some new light upon this problem, we have, in a retrospective review of patients recently admitted with cerebral infarction, attempted to retrace the exact time of onset in each patient. In addition, we studied the type of infarction (in the territory of a single artery or between different territories), as this provides some evidence for embolism or haemodynamic factors, respectively. Patients and methodsBetween 1 January 1984 and 1 September 1985, 99 patients were diagnosed as having cerebral infarction. To facilitate comparison with one previous study,' we adopted the same criteria for "stroke of acute onset", in that symptoms should have reached their maximum in less than 6 hours and should Address for reprint requests: Prof J van Gijn,

Nutrition in Chronocardiology: We are Indebted Professor Franz Halberg

“…The occurrence of cerebral infarction has been reported to vary with the time of day; cerebrovascular ischemic events predominantly occur in the early morning and late afternoon [91,101,[106][107][108][109]. Subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) are associated with a high morbidity and mortality, and they represent about 20% of all strokes [106].…”

Very Early Morning Increase in Onset of Ischemic Stroke

“…[10][11][12][13][14][15][16][17][18] Although several previous reports of diurnal variation in stroke suggested that stroke was more common at night during sleep, 1,19 no reasonable explanation is provided for the pathophysiologic mechanism leading to cerebral infarction. The possibility that stroke occurs during sleep but is noticed when the patient wakes up in the morning was ruled out in previous studies.…”

“…This is about two hours earlier than in most of the previous reports. [9][10][11][12][13][14][15] Different awakening times may be an acceptable explanation for this discrepancy. In Moslem populations, elderly people wake up very early in the morning to perform the first of their daily ritual prayers.…”

“…8,9 Similar circadian variation of cerebral ischemia was also reported but with contradictory findings. [10][11][12][13][14][15][16] While there are considerable variations in patient populations and methods, most of the previous studies note a peak onset in the morning hours, [17][18][19] particularly at the time of awakening. …”

“…8,9 Similar circadian variation of cerebral ischemia was also reported but with contradictory findings. [10][11][12][13][14][15][16] While there are considerable variations in patient populations and methods, most of the previous studies note a peak onset in the morning hours, [17][18][19] particularly at the time of awakening. 20 The aim of the present study was to investigate the possibility that acute ischemic stroke (IS) has a circadian variation and IS occurs more often at certain times of the day in Turkish sufferers whose awakening time is probably different from western populations.…”