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Diurnal variation of and activity during the onset of stroke
Insights
Stroke incidence shows a diurnal pattern, peaking around late morning for all types. Specific stroke types are linked to particular activities and times of day, with hypertension playing a role in intracerebral hemorrhage.
Area of Science:
- Neurology
- Chronobiology
- Epidemiology
Background:
- Stroke is a leading cause of death and disability worldwide.
- Understanding the temporal patterns of stroke onset is crucial for prevention and timely intervention.
- Previous research suggests diurnal variations in stroke occurrence, but specific patterns across different stroke subtypes require further investigation.
Purpose of the Study:
- To investigate the diurnal variation in the onset of different stroke types (subarachnoid hemorrhage, intracerebral hemorrhage, thromboembolic cerebral infarction) in elderly patients.
- To explore the association between stroke onset time, patient demographics, hypertension status, and specific daily activities.
Main Methods:
- A study of 557 consecutive patients over 70 years old with confirmed stroke.
- Categorization of patients into three stroke groups: subarachnoid hemorrhage (194), intracerebral hemorrhage (118), and thromboembolic cerebral infarction (245).
- Analysis of stroke onset times, patient's blood pressure status, and reported daily activities preceding stroke.
Main Results:
- All stroke types demonstrated a peak incidence between 10:00 and 12:00 hours.
- Intracerebral hemorrhages were less frequent between 04:00 and 06:00 hours.
- Subarachnoid hemorrhage was more common during lavatory use, sexual activity, or sports; intracerebral hemorrhage during driving or alcohol consumption; and cerebral infarction during sleep or upon waking.
Conclusions:
- Stroke onset exhibits significant diurnal variation, with a common morning peak across major subtypes.
- Specific stroke types are associated with distinct daily activities and physiological triggers.
- While hypertension did not alter stroke onset timing, a higher prevalence of untreated hypertension was noted in intracerebral hemorrhage patients, suggesting its role in this subtype.
Abstract:
The diurnal variation in the onset of stroke was examined in 557 consecutive patients aged over 70 years. These included 194 patients with subarachnoid hemorrhage, 118 with intracerebral hemorrhage, and 245 with thromboembolic cerebral infarction. All three types of strokes exhibited a peak incidence between 1000 and 1200 hours. Intracerebral hemorrhages occurred less frequently between 0400 and 0600 hours, but there were no differences between the groups for the other time periods. There was no difference in the time of onset of stroke between normotensive and treated or untreated hypertensive patients. There were more untreated hypertensive patients in the intracerebral hemorrhage group than in the other stroke type groups. Subarachnoid hemorrhage occurred more frequently in the lavatory and during sexual and sporting activity. Intracerebral hemorrhage occurred more commonly during driving or the consumption of alcohol. Cerebral infarction occurred more frequently during sleep or was noticed on waking. No differences were found for the other activities examined. The relationship between diurnal variation in stroke and the known variation in blood pressure is discussed.