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.
© 1998 American Heart Association, Inc.
Original Contributions
Circadian Variation in Acute Ischemic Stroke
A Hospital-Based Study
Key Words: circadian rhythm • stroke onset • ischemia
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