Circadian Variations of Hemodynamics and Stroke

Hossmann, V.; Zülch, K. J.

doi:10.1007/978-3-642-67316-0_17

Cited by 14 publications

(10 citation statements)

References 31 publications

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“…Regarding circadian time, our results are similar to those of other previous studies (5)(6)(7)(8), whereas another study that evaluated cerebral infarction reports maximum incidence from 0600 to 1800 (9).…”

Section: Discussionsupporting

confidence: 91%

Epidemiological chronorisk of stroke

Pasqualetti

Natali

Casale

et al. 2009

Acta Neurologica Scandinavica

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A retrospective study was undertaken on onset of symptoms in 667 cases of stroke. All strokes occurred out of hospital. There were 382 males and 285 females, observed from 1971‐1988. The 667 cases of stroke consisted of 508 cases of cerebral infarction and 159 cases of cerebral hemorrhage. The data, analyzed by the single cosinor method, demonstrate a significant circadian, circaseptan, and circannual rhythmicity in the occurrence of stroke. The peaks occur in the morning hours, in the weekend, and in winter. Cerebral hemorrhages do not have a circadian rhythmicity in their occurrence, while they do present circaseptan and circannual rhythmicity. Cerebral infarctions present circadian, circaseptan, and circannual rhythms. No difference was found between males and females. The possible factors involved in temporal distribution of stroke are discussed. These observations could be useful for a better understanding of the pathogenesis and treatment of stroke.

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Section: Discussionsupporting

confidence: 91%

Epidemiological chronorisk of stroke

Pasqualetti

Natali

Casale

et al. 2009

Acta Neurologica Scandinavica

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“…If the scan did not show a relevant infarct and the stroke onset had been less than 3 days before, it was repeated approximately 10 days later. Four types of infarcts were distinguished: (1) infarct in the territory of a main arterial trunk (complete or incomplete); (2) lacunar infarct, in the deep regions of the brain or brain stem; (3) watershed infarct, between the cortical territories of the main arterial trunks, or between the territories of the superficial and deep branches of the middle cerebral artery; (4) no lesion visible; these were either patients with the clinical signs of lacunar infarction but with lesions undetected by CT, or patients with severe deficits of less than 48 hours duration in whom CT could not be repeated because of early death from brain swelling and herniation.…”

Section: Methodsmentioning

confidence: 99%

Cerebral infarction does not occur typically at night.

Windt

Gijn

1988

Journal of Neurology, Neurosurgery & Psychiatry

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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,

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“…[2][3][4][5] Early studies of the timing of acute stroke, however, indicated that many afflicted patients reported awakening with new neurologic deficits, and several reports indicated that acute strokes tended to occur either during the evening hours or during sleep. [6][7][8] This led to the conclusion that especially because acute therapies for stroke-in-evolution were not particularly effective, there was little reason to consider acute stroke as a medical emergency because the onset of symptoms was thought to occur during sleep, when most patients would not recognize them.…”

mentioning

confidence: 99%

Circadian Variation in the Timing of Stroke Onset

Elliott

1998

Stroke

587

396

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Background and Purpose-Acute myocardial infarction and sudden death display a circadian rhythm, with a higher risk between 6 AM and noon. Some reports suggest that stroke does not follow such a circadian variation and that hemorrhagic stroke occurs more often during the evening. Methods-A meta-analysis of 31 publications reporting the circadian timing of 11 816 strokes was performed, subdividing (when possible) by the type of stroke, according to the time of onset of symptoms. When precise timing was not given, strokes were distributed evenly (that is, biasing toward the null hypothesis of lack of circadian variation). Results-All subtypes of strokes displayed a significant (PϽ0.001) circadian variation in time of onset, whether divided into 3-, 4-, or 6-hour time periods. There was a 49% increase (95% confidence interval, 44% to 55%) in stroke of all types between 6 AM and noon (compared with expectations if no circadian variation was present), which is a 79% (95% confidence interval, 72% to 87%) increase over the normalized risk of the other 18 hours of the day. There were 29% fewer strokes between midnight and 6 AM, a 35% decrease compared with the other 18 hours of the day. All three subtypes of stroke had a significantly higher risk between 6 AM and noon (55% for 8250 ischemic strokes; 34% for 1801 hemorrhagic strokes, and 50% for 405 transient ischemic attacks). Conclusions-These data support the presence of a circadian pattern in the onset of stroke, with a significantly higher risk in the morning. (Stroke. 1998;29:992-996.)

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Circadian Variations of Hemodynamics and Stroke

Cited by 14 publications

References 31 publications

Epidemiological chronorisk of stroke

Epidemiological chronorisk of stroke

Cerebral infarction does not occur typically at night.

Circadian Variation in the Timing of Stroke Onset

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