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Patient Demographic and Clinical Features and Circadian Variation in Onset of Ischemic Stroke
Ilaria Casetta, MD;
Enrico Granieri, MD;
Elisa Fallica, MD;
Olga la Cecilia, MD;
Ezio Paolino;
Roberto Manfredini, MD
Arch Neurol. 2002;59:48-53.
Background Studies have reported circadian variation in the onset of ischemic stroke,
which may carry important pathophysiological implications. However, there
is no detailed information about circadian variations among the subtypes of
stroke.
Objective To determine whether subgroups of patients with ischemic stroke with
specific clinical characteristics would exhibit different circadian patterns,
to more systematically examine the role of possible triggering or precipitating
factors.
Design and Setting Analysis of the effects of demographic, medical, and pathophysiological
factors on the circadian pattern of an unselected series of patients with
ischemic stroke consecutively admitted to our hospital.
Results The study included 1656 patients. As in other studies, the peak of stroke
onset occurred in the morning, with a second peak in the evening. Circadian
variation in ischemic stroke onset was shown to be independent of clinical
variables considered.
Conclusions Our study confirms the circadian rhythm of stroke reported in previous
studies. There is a chronological pattern of ischemic stroke in the morning,
which appears to be independent of the presence of risk factors and of clinical
stroke subtypes. The role of circadian variability of blood pressure (present
in patients with and without hypertension) and a concurrent morning hypercoagulability
are suggested as possible determinants of this pattern. Preventive pharmacological
interventions aimed at specifically targeting the morning rise in risk factors
could be advantageous in reducing the overall risk of ischemic stroke.
From the Sections of Clinical Neurology (Drs Casetta, Granieri, and
Fallica and Mr Paolino) and First Internal Medicine (Drs la Cecilia and Manfredini),
University of Ferrara, Ferrara, Italy.
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