Temporal Patterns of Stroke Onset

Kelly-Hayes, Margaret; Wolf, Philip A.; Kase, Carlos S.; Brand, Frederick N.; McGuirk, Jacqueline M.; D’Agostino, Ralph B.

doi:10.1161/01.str.26.8.1343

Cited by 201 publications

(168 citation statements)

References 23 publications

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“…Similar to several ongoing therapeutic trials for WUS, we used the time since symptom recognition to select a subgroup of patients with WUS comparable with patients with STW. Studies suggest that WUS occurs predominantly in the early hours of the morning 1,8 ; therefore, the more suitable time point for defining WUS onset and for defining a therapeutic window may be that of symptom recognition rather than time since last known normal. Our findings are in accordance to the evidence that clinical and early CT findings in WUS patients are not different from patients with stroke of known onset, [9][10][11][12][13] and suggest that WUS may occur predominantly in a time period shortly before awakening.…”

Section: Discussionmentioning

confidence: 99%

Wake-up Stroke and Stroke within the Therapeutic Window for Thrombolysis Have Similar Clinical Severity, Imaging Characteristics, and Outcome

Costa

Pinho

Alves

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

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Background: Wake-up stroke (WUS) represents 25% of all ischemic strokes. There is conflicting evidence concerning clinical severity, imaging characteristics, and outcome when WUS is compared with stroke of known time of onset. Our aim was to compare WUS patients with patients with ischemic stroke within the therapeutic window (STW) for thrombolysis. Methods: This is a retrospective hospitalbased study of all consecutive patients hospitalized for acute ischemic stroke during 2013. Patients with STW, WUS, and WUS with computed tomography (CT) at 3 hours or less after awakening (WUS≤3h) were selected for the study. The methods used include a review of clinical records, an independent quantification of early signs of ischemia on admission CT scan, and determination of functional outcome on follow-up. Results: Of 554 patients evaluated, 190 had STW, 113 had WUS (20.4%), and 25 had WUS≤3h. Among all WUS patients, 33.6% did not have any other formal contraindication for thrombolysis besides undetermined time of onset. WUS patients had demographic characteristics, vascular risk factors, and clinical severity similar to STW patients. Mild or absent early signs of ischemia on admission CT in WUS≤3h patients were similar to those in STW patients when adjusted for clinical severity (odds ratio [OR] = .50, 95% confidence interval [CI]=.17-1.47). Favorable prognosis in WUS≤3h was similar to STW when adjusted for age, clinical severity, and thrombolysis (OR = .53, 95% CI=.09-3.14). Conclusions: This study strengthens the evidence that clinical and early imaging characteristics of WUS patients are similar to those of patients with stroke who are eligible for thrombolysis based on the time window criteria, and patients with WUS do not have a worse short outcome. Key Words: Wake-up stroke-ischemic stroke-computed tomography-stroke outcome.

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Section: Discussionmentioning

confidence: 99%

Wake-up Stroke and Stroke within the Therapeutic Window for Thrombolysis Have Similar Clinical Severity, Imaging Characteristics, and Outcome

Costa

Pinho

Alves

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

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“…Indeed, most studies which could not detect a statistical significance in seasonal variation in SAH onset analyzed only a small number of SAH patients since main target of the study was ischemic stroke. 9,17,20,23) Secondly, patient selection criteria and sampling design are also important. A community-based incidence study is ideal to investigate the epidemiological aspects of 3) Ferrana, Italy 199 adm hb x 2 peaks in spring and fall (p º 0.05) Mizuno (1996) 16) Nagano, Japan 632 adm hb nm trough in July Rothwell et al (1996) 20) Oxfordshire, U.K. 33 inc cb Walter peak in spring * Results were not statistically significant when p value is not presented.…”

Section: Discussionmentioning

confidence: 99%

Differential Effects of Activity and Climate on Onset of Subarachnoid Hemorrhage.

Kawai

Nonaka

Suzuki

et al. 2001

Neurol. Med. Chir.(Tokyo)

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Conflicting findings of the effect of climate on onset of subarachnoid hemorrhage (SAH) may result from the influence of strenuous activities which can trigger aneurysmal rupture independent of climatological factors. The effect of climate and patient activities on onset of SAH were analyzed. The clinical records of 786 consecutive patients with aneurysmal SAH admitted to our hospital for 10 years were reviewed. Activities at onset were categorized according to the intensity of strain at onset. Seasonal variation, circannual cyclic trend, and association with 90 meteorological factors were examined in each category and the results were compared between categories. Bimonthly occurrence in the light strain group showed a significant seasonal variation and cyclic trend with two peaks in early spring and fall, whereas no significant trend was detected in the overall patients and in the heavy strain group. The significant meteorological factors were global solar radiation, sunshine hours, changes in mean and minimum temperature and mean vapor pressure from the previous day, and minimum pressure in the previous 7 days. Lower global solar radiation in the light strain group was associated with onset with the lowest p value (p ＝ 0.0046). No factors were significant in the heavy strain group. There is some evidence of the possible influence of climatological factors on onset of SAH without strenuous activity. Strenuous activity seems to affect onset more strongly, which masks any effect of climate.

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“…Studies were conducted in many countries and reported that incidence of stroke has irregular time pattern, and that different frequency of occurence is observed in days of the week and in months of the year (4,5). Analysis on temporal pattern of stroke occurence can help in clarification of mehanisms that we can consider as trigers of this diseases occurence (2,4,6,7).…”

Section: Introductionmentioning

confidence: 99%

Temporal Variations of Stroke Occurence

Simovic

Aleksić

Matic

et al. 2017

Serbian Journal of Experimental and Clinical Research

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Stroke is one of leading causes of death worldwide. Different frequency of stroke occurence is observed in days of the week and months in the year, and incidence of stroke has irregular time pattern. We analyzed 516 patients who had acute stroke and were treated in Clinic of Neurology, Clinical Center Kragujevac from January 1, 2013 to January 1, 2014, mean age 72,11±11,52. Statistical analysis is conducted out using the SPSS software version 20.0. We used descriptive statistic, student T-test, chi-square or Fisher exact test.Friday is day we found the most IS and all stroke types occurences, and Wednesday is day we found the most IS in men. We found the most strokes in women younger than 65 years on Wednesday, but in women older than 65 years on Friday. Monday is day with the most admissions to hospital for patients with IS, and we observed that there is average delay in the refering to the doctor for 1.80±1.44 days. Friday is the day with the most ICH symptom beginings and the most admissions to the hospital, and Saturday is the day with the least symptom beginings and admissions to the hospital in the case of IS and ICH. The most IS occured in winter (in Decembar), and the least in summer (in August). The most ICH occured in May, and the least in July and October.We confirmed that there is a significant weekly variability in the IS symptom onset day.

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Temporal Patterns of Stroke Onset

Abstract: Temporal patterns of stroke onset were observed for season, day of the week, time of day, and place in a community-based population. These findings suggest that there are periods of increased risk of stroke that may be amenable to preventive strategies.

Cited by 201 publications

References 23 publications

Wake-up Stroke and Stroke within the Therapeutic Window for Thrombolysis Have Similar Clinical Severity, Imaging Characteristics, and Outcome

Wake-up Stroke and Stroke within the Therapeutic Window for Thrombolysis Have Similar Clinical Severity, Imaging Characteristics, and Outcome

Differential Effects of Activity and Climate on Onset of Subarachnoid Hemorrhage.

Temporal Variations of Stroke Occurence

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