Volume 1, Issue 2 (Summer 2015)                   Caspian.J.Neurol.Sci 2015, 1(2): 15-19 | Back to browse issues page


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Hosseininezhad M, Hatamian H, Bakhshayesh-Eghbali B, Moaddabi Y. A Survey about the Temporal Pattern of Stroke Occurrence. Caspian.J.Neurol.Sci. 2015; 1 (2) :15-19
URL: http://cjns.gums.ac.ir/article-1-49-en.html
1- Department of Neurology, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
2- Department of Neurology, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran ; yasermoadabi@yahoo.com
Keywords: Stroke, Circadian, Variation
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ABSTRACT

Background: Temporal variation of stroke onset is suggested in some studies contained somewhat varieties. It is proposed that some predisposing changes occur in some ascertained times consequently resulted in stroke occurrence in some special times.

Objective: To determine the circadian and circaseptan variation of stroke onset.

Materials and Methods: This cross sectional study was conducted from March 2012 to February 2013 in an academic hospital in the North of Iran. All patients with acute onset of neurological symptoms were enrolled in the study after being diagnosed as a stroke patient. The diagnosis was made by a neurologist using brain imaging. Age, gender, history of diabetes and hypertension, time and date of stroke onset were recorded for all patients. The data were analysed using Chi-square test in SPSS software version19.

Results: A total of eight hundred sixty-nine patients with mean age of 67.5±12.4 years (55.6% women 44.4% men) were admitted during one year study. Eighty-five percent of stroke cases were ischemic in nature and the others were hemorrhagic type. Distribution of cases during a day was not uniform (p < 0.0001). The peak of stroke onset occurred in the mornings (7-9 a.m.) followed by a second peak in the evenings (7-9 p.m.). In addition, the distribution of cases during the week was also not uniform (p < 0.016).

Conclusion: Stroke occurrence has a diurnal variation probably resulted from circadian physiologic changes. Although there is a circaseptan variation in the times of stroke record, it seemingly isn’t related to physiologic changes.

Keywords: Stroke; Circadian; Variation

Introduction

Stroke is a serious public health issue and is the second leading cause of death worldwide and is a major cause of disability in adults. In the United States, figures indicate a total of 5,800,000 prevalent stroke cases, with 780,000  first-ever or recurrent strokes expected in each year (1,2). Stroke is a global epidemic event and about eighty-five percent of all death due to stroke was occurred in low income and developing countries (3).

With aging of population an increase in incidence of stroke will occur. Until 2030, seventy five percent of world's old people will live in developing countries. In the Middle East the mortality of stroke will increased by twofold until 2030 (4).

Stroke occurrence shows chronobiological variations, such as circannual, circaseptan and also circadian variations. Various patterns have been reported but no conclusions have been achieved on circadian variations yet (5,6,7). Understanding the temporal patterns of stroke incidence and its fatality can offer an opportunity to identify the potentially critical times and to develop preventive strategies (8). Understanding the times in a day or the days of a week in which more strokes occur could help the hospitals to be prepared for sudden increases in the numbers of stroke admissions. Some treatments of stroke such as intravenous tissue plasminogen activator (t-PA) should be used in a narrow time window after stroke onset. Because of existence a few data about the temporal pattern of stroke (9,10,11) we decided to investigate the temporal pattern of stroke occurrence.

Materials and Methods

This cross sectional study was conducted from March 2012 to February 2013 in an academic hospital in the North of Iran. All patients with acute onset of neurological symptoms were enrolled in the study. Brain imaging studies including brain Computed Tomography (CT) and/or Magnetic resonance imaging (MRI) were carried out for all of them and an expert neurologist confirmed the diagnosis of stroke. Patients with other diagnosis based on imaging studies (e.g. brain tumors, subdural hematoma and etc.); patients with transient symptoms and normal brain MRI were excluded.

Age, gender, history of diabetes and hypertension, time and date of stroke occurrence and the stroke subtype were recorded for all patients. Recalling the exact time of stroke was definitely impossible; so the time of stroke occurrence was recorded by approximation, for example the range of time from 6:31 to 7:30 was recorded as 7.00 o'clock.

The data were analyzed using Chi-square test in SPSS software version 19.

Results

A total of eight hundred sixty-nine stroke patients were admitted to hospital during the study period. The time of stoke onset was not identified by fourteen cases. The mean age of patient was 67.5±12.4 years (range of 22-94 years). Totally 44.4% of patients were men with mean age of 67.32±12.5 years and 55.6% were women who their mean age was 67.71±12.33 years.

A hundred nine patients (12.5%) involved by intra-cerebral hemorrhage (ICH), 739 patients (85%) by ischemic stroke and 21 patients (2.5%) had subarachnoid hemorrhage (SAH) with mean age of 64.2, 68.4 and 51.8 years, respectively.

In taking past medical history, a total of four hundred eighty-four patients (55.7%) reported hypertension and 266 patients (30.6%) stated to have diabetes mellitus.

Regarding the time of stroke onset, more strokes occurred at 7 and 8 a.m. and a second peak occurred at 7 and 8 p.m. (Diagram 1). With dividing the day to eight 3 hours times, the peak of stroke occurrence was during 7 to 9 a.m. (p < 0.0001).