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Published on: August 18, 2015
Circadian Variability in Pediatric Arterial Ischemic Stroke
Sarah Lee1, Anirudh Sreekrishnan2, Michael Mlynash1
1Stanford Stroke Center, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Insights
Pediatric ischemic stroke shows circadian variability, with most events occurring in the afternoon. Nighttime strokes were linked to arteriopathy risk factors, suggesting different underlying causes and potential treatment implications.
Area of Science:
- Neurology
- Pediatrics
- Circadian Biology
Background:
- Ischemic stroke is a significant cause of childhood morbidity.
- Understanding the temporal patterns of stroke onset is crucial for developing effective prevention and treatment strategies.
Purpose of the Study:
- To investigate whether the timing of ischemic stroke onset exhibits circadian variability in pediatric patients.
- To explore potential differences in stroke characteristics and outcomes based on the time of day.
Main Methods:
- A retrospective cohort study was conducted using data from a large, multicenter pediatric stroke registry.
- Children with arterial ischemic stroke and known onset times were analyzed.
- Stroke onset times were categorized into four epochs: morning, afternoon, evening, and night.
- Statistical tests (Kruskal-Wallis, chi-square) were used for comparisons.
Main Results:
- A total of 478 children were included, with a mean age of 9.9 years.
- The highest frequency of strokes occurred in the afternoon (38.7%), followed by the morning (32.6%).
- Arteriopathy risk factors were more common in nighttime strokes (P = .034).
- Younger age groups (<11 years) showed a higher proportion of afternoon strokes.
Conclusions:
- Circadian patterns of ischemic stroke in children appear distinct from those observed in adults.
- These findings highlight the need for tailored stroke care systems and treatment approaches for pediatric populations.
- Further research may elucidate the specific mechanisms driving these temporal variations.
Objective:
To assess whether the timing of ischemic stroke onset demonstrates circadian variability in children.
Study Design:
We performed a retrospective cohort study evaluating children with arterial ischemic stroke and known time of stroke onset who were enrolled in a large, multicenter pediatric stroke registry. Clinical and radiographic features were compared according to 4 time epochs-6:00-11:59 (morning), 12:00-17:59 (afternoon), 18:00-23:59 (evening), and 00:00-5:59 (night)-using Kruskal-Wallis and chi-square tests. Pairwise comparisons were conducted when needed.
Results:
A total of 478 patients were included, with 54% male and a mean age of 9.9 ± SD 5.7 years. We observed a rise in stroke frequency in the morning that plateaued around 10:00, with a sustained high frequency into the early afternoon; most strokes occurred in the afternoon (n = 185, 38.7%), followed by the morning (n = 156, 32.6%). Arteriopathy risk factors were more prevalent in nighttime strokes (23/36, P = .034). Patients in the <2, 2-5, and 6-11-year-old age groups had a higher proportion of strokes in the afternoon (42%, 38%, and 45%, respectively). There was a trend for better median 6-month pediatric stroke outcome measure scores after evening strokes (0.5, IQR 0-1.5) compared with morning strokes (1, IQR 0.5-2) and afternoon strokes (1, IQR 0.5-3), P = .033, but this was not statistically significant after adjustment for multiple comparisons.
Conclusions:
Circadian influence on stroke timing appears to differ between adults and children. These findings could influence stroke systems of care and treatment strategies for pediatric stroke.
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