This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lago, A. Articles by Baquero, M. Search for Related Content PubMed PubMed Citation Articles by Lago, A. Articles by Baquero, M.

(Stroke. 1998;29:1873-1875.)
© 1998 American Heart Association, Inc.

Original Contributions

Circadian Variation in Acute Ischemic Stroke

A Hospital-Based Study

Aida Lago, MD; Daniel Geffner, MD; José Tembl, MD; Lamberto Landete, MD; Caridad Valero, MD; Miguel Baquero, MD

From the Department of Neurology, Hospital Universitari La Fe (A.L., J.T., L.L., C.V., M.B.), Valencia, and the Department of Neurology, Hospital General (D.G.), Castellón, Spain.

Correspondence to Aida Lago, Department of Neurology, Hospital Universitari la Fe, Avda Campanar 21, 46.009 Valencia, Spain. E-mail alagom{at}meditex.es

Background and Purpose—We investigated circadian rhythm in ischemic stroke onset and its subtypes, differentiating between first-ever stroke and recurrent stroke.

Methods—A consecutive series of 1223 patients with ischemic stroke was admitted at 2 reference hospitals; the time of onset of symptoms was obtained, differentiating between onset while asleep and awake. We compared circadian rhythm between stroke types and between first-ever and recurrent stroke.

Results—The onset time was known in 914 patients; 25.6% experienced onset on awakening [higher incidence in thrombotic and lacunar stroke (28.9% and 28.4%, respectively) than in embolic stroke (18.8%)]. For all stroke subtypes, there was a significant diurnal variation, with a morning peak between 6 AM and noon; after redistributing the hour of onset of patients awakening with stroke, the morning peak was minimal in all types of stroke. There were no differences in circadian rhythm between patients with first-ever and recurrent stroke.

Conclusions—Only hospitalized patients were studied. There is a circadian rhythm in all types of stroke, with higher frequency during the day and lower frequency in the last hours in the evening. The highest incidence in the early hours of the morning can be overestimated, due to patients who awaken with stroke. There is no difference in circadian rhythm between first-ever stroke and recurrent stroke.

Key Words: circadian rhythm • stroke onset • ischemia

This article has been cited by other articles:

				C. Foerch, H.-W. Korf, H. Steinmetz, M. Sitzer, and for the Arbeitsgruppe Schlaganfall Hessen (ASH) Abrupt Shift of the Pattern of Diurnal Variation in Stroke Onset With Daylight Saving Time Transitions Circulation, July 15, 2008; 118(3): 284 - 290. [Abstract] [Full Text] [PDF]

				S Omama, Y Yoshida, A Ogawa, T Onoda, and A Okayama Differences in circadian variation of cerebral infarction, intracerebral haemorrhage and subarachnoid haemorrhage by situation at onset J. Neurol. Neurosurg. Psychiatry, December 1, 2006; 77(12): 1345 - 1349. [Abstract] [Full Text] [PDF]

				I. Kriszbacher, M. Koppan, J. Bodis, H.-K. Yip, S.-S. Chen, and M.-C. Chen Aspirin for Stroke Prevention Taken in the Evening? * Response: Stroke, December 1, 2004; 35(12): 2760 - 2762. [Full Text] [PDF]

				I. Casetta, E. Granieri, E. Fallica, O. la Cecilia, E. Paolino, and R. Manfredini Patient Demographic and Clinical Features and Circadian Variation in Onset of Ischemic Stroke Arch Neurol, January 1, 2002; 59(1): 48 - 53. [Abstract] [Full Text] [PDF]

				S. Passero, F. Reale, G. Ciacci, and E. Zei Differing Temporal Patterns of Onset in Subgroups of Patients With Intracerebral Hemorrhage Stroke, July 1, 2000; 31(7): 1538 - 1544. [Abstract] [Full Text] [PDF]

				C. Bassetti and M. Aldrich Night time versus daytime transient ischaemic attack and ischaemic stroke: a prospective study of 110 patients J. Neurol. Neurosurg. Psychiatry, October 1, 1999; 67(4): 463 - 467. [Abstract] [Full Text] [PDF]