scholarly journals Circadian variation of stroke: a hospital based study

2014 ◽  
Vol 87 (4) ◽  
pp. 242-249 ◽  
Author(s):  
Dana Marieta Fodor ◽  
Ioana Babiciu ◽  
Lacramioara Perju-Dumbrava
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Demographic Data ◽  
Circadian Variation ◽  
Onset Time ◽  
Consecutive Series ◽  
Circadian Pattern ◽  
Vascular Risk ◽  
Stroke Subtypes

Aims and BackgroundThe circadian pattern of stroke occurrence variation has been recognized with certain differences between authors and stroke types. The underlying reason may be related to exogenous factors (cyclic physical activity, including sleep–awake cycles and assuming the up-right posture) and endogenous factors, with their diurnal variation (blood pressure, hemostatic balance, autonomic system activity). The aims of the present study are to investigate the existence of a circadian variation of stroke and the possible differences between stroke subtypes in the Cluj Napoca area.Materials and MethodThe stroke event data were acquired from the Patient Records of a consecutive series of 1083 patients admitted through the Emergency Room at Neurology Departments I and II of the District Hospital of Cluj Napoca, between 1 January 2012 and 31 December 2012. The classifiable onset time was assigned to one of four six-hour intervals: 00.01-06.00 (night), 06.01-12.00 (morning), 12.01-18.00 (afternoon) and 18.01-24.00 (evening). Demographic data and vascular risk factors were recorded.ResultsAll three stroke types (ischemic stroke, hemorrhagic stroke and subarachnoid hemorrhage) have shown a circadian variation regarding their occurrence, with the peak of incidence in the morning and the nadir during nighttime. This circadian pattern is independent by demographic factors and vascular risk factors.ConclusionOur study confirmed the circadian variation of onset occurrence for all stroke subtypes. Some triggering factors promote ischemic stroke and prevent hemorrhagic stroke. The diurnal pattern of variation with the higher incidence in the morning and the lower in the night may lead to chrono-therapeutic and preventive approach (chrono-therapy of the risk factors), which targets the period of the highest vulnerability after awaking.

scholarly journals Stroke Care in Young Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
L. Tancredi ◽  
F. Martinelli Boneschi ◽  
M. Braga ◽  
I. Santilli ◽  
C. Scaccabarozzi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Clinical Care ◽  
Young Patients ◽  
Stroke Care ◽  
Diagnostic Process ◽  
Consecutive Series ◽  
Digital Subtraction ◽  
Vascular Risk ◽  
Pfo Closure

The aims of this study were (i) to evaluate the clinical features of a consecutive series of young patients with ischemic stroke and (ii) to assess the changes in the clinical management of these patients over the study period. All consecutive cases of young adults aged 16 to 44 years, with ischemic stroke, that were admitted between 2000 and 2005 in 10 Italian hospitals were included. We retrospectively identified 324 patients. One or more vascular risk factors were present in 71.5% of the patients. With respect to the diagnostic process, an increase in the frequency of cerebral noninvasive angiographic studies and a decrease in the use of digital subtraction angiography were observed (P<0.001andP=0.03, resp.). Undetermined causes decreased over 5-year period of study (P<0.001). The diagnosis of cardioembolism increased. Thrombolysis was performed for 7.7% of the patients. PFO closure (8%) was the most frequently employed surgical procedure. In conclusion, the clinical care that is given to young patients with ischemic stroke changed over the study period. In particular, we detected an evolution in the diagnostic process and a reduction in the number of undetermined cases.

scholarly journals Infratentorial posterior circulation stroke in a Nigerian population: Clinical characteristics, risk factors, and predictors of outcome

2016 ◽  
Vol 7 (01) ◽  
pp. 72-76 ◽  
Author(s):  
Lukman Femi Owolabi ◽  
Aliyu Ibrahim ◽  
Ibrahim Musa
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Clinical Characteristics ◽  
Hemorrhagic Stroke ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Posterior Circulation ◽  
Predictors Of Outcome ◽  
Posterior Circulation Stroke

ABSTRACT Background: Posterior circulation stroke (PCS), though less common, differs from stroke in anterior circulation in many aspects. Relatively, it portends a poorer prognosis. However, there is a paucity of data from African countries, in particular, where stroke is a menace. Objective: The study aimed to evaluate the etiology, clinical characteristics, outcome, and predictors of outcome in a cohort of patients with IPCS in Northwestern Nigeria. Materials and Methods: Out of 595 patients with stroke, we prospectively analyzed 57 patients with PCS in a Tertiary Care Center in Kano, Northwestern Nigeria. Patients were analyzed for demographic data, risk factors, clinical characteristics, stroke subtypes, mortality, and predictors of mortality. Results: Posterior circulation ischemic stroke accounted for 57 (9.6%) of 595 of all strokes seen in the study period. They comprised 44 males (mean age 47.8 ± 17.7) and 13 females (mean age 46.3 ± 13.7). Overall, their age ranged between 24 and 90 (mean age 47.4 ± 16.7). However, 52.7% of the patients were < 45 years of age. The most common site affected was the cerebellum seen in 33 (57.9%) patients. Hypertension was the most common risk factor (86%). Headache and vertigo were the most common features accounting for 83.6% and 86.3%, respectively. Thirty-eight (66.7%) patients had an ischemic stroke. Twenty-one (36.8%) of the patients died during the 1-month period of follow-up. Independent predictors of death in the study were hyperglycemia on admission and hemorrhagic stroke. Conclusions: IPCS occurred in a relatively younger age group. Headache and vertigo were the most common symptoms. The independent predictors of death in the study were hyperglycemia at presentation and hemorrhagic stroke.

scholarly journals Sex differences in the association between major risk factors and the risk of stroke in the UK Biobank cohort study

Neurology ◽  
2020 ◽  
Vol 95 (20) ◽  
pp. e2715-e2726 ◽  
Author(s):  
Sanne A.E. Peters ◽  
Cheryl Carcel ◽  
Elizabeth R.C. Millett ◽  
Mark Woodward
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Ischemic Stroke ◽  
Low Socioeconomic Status ◽  
Hemorrhagic Stroke ◽  
Uk Biobank ◽  
Cox Models ◽  
Stroke Subtypes ◽  
The Uk

ObjectiveTo determine whether there are sex differences in the association between risk factors and incident stroke, including stroke subtypes.MethodsA total of 471,971 (56% women) UK Biobank participants without a history of cardiovascular disease were included. During 9 years of follow-up, 4,662 (44% women) cases of stroke were recorded. Cox models yielded adjusted hazard ratios (HRs) and women-to-men ratios of HRs (RHRs) for stroke associated with 7 risk factors.ResultsThe incidence rate per 10,000 person-years was 8.66 (8.29–9.04) in women and 13.96 (13.44–14.50) in men for any stroke, 6.06 (5.75–6.38) in women and 11.35 (10.88; 11.84) in men for ischemic stroke, and 1.56 (1.41–1.73) in women and 2.23 (2.02–2.45) in men for hemorrhagic stroke. The association between increases in blood pressure, body anthropometry, and lipids, diabetes, and atrial fibrillation and any stroke was similar between men and women. Hypertension, smoking, and a low socioeconomic status were associated with a greater HR of any stroke in women than men; the RHRs were 1.36 (1.26–1.47), 1.18 (1.02–1.36), and 1.17 (1.03–1.33), respectively. Diabetes was associated with a higher HR of ischemic stroke in women than men (RHR 1.25 [1.00–1.56]). Atrial fibrillation was associated with a higher HR of hemorrhagic stroke in women than men (RHR 2.80 [1.07–7.36]).ConclusionSeveral risk factors are more strongly associated with the risk of any stroke or stroke subtypes in women compared with men. Despite this, the incidence of stroke remains higher among men than women.

scholarly journals An observational study from a new tertiary care hospital in North Odisha: clinical and etiological profile of acute ischemic stroke patients

2019 ◽  
Vol 6 (5) ◽  
pp. 1605
Author(s):  
Bibhu P. Behera ◽  
Partha S. Mohanty
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Observational Study ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Tertiary Care ◽  
Care Hospital ◽  
Stroke Patients ◽  
Middle Income ◽  
Stroke Subtypes

Background: Worldwide, cerebrovascular accidents (stroke) are the second leading cause of death and the third leading cause of disability. According to WHO estimation, by 2050 nearly 80% of stroke cases may occur in low and middle-income countries like China and India. It is critical that we understand the etiology causing the stroke so that appropriate treatment can be initiated in a timely fashion. Furthermore, understanding the risk factors associated with stroke is important before primary and secondary preventive measures can be prescribed to the patient.Methods: This observational study was carried out amongst 481 acute ischemic stroke patients that fulfils the inclusion and exclusion criteria and admitted in medicine ward of Pandit Raghunath Murmu Medical College and Hospital, Baripada, Dist. Mayurbhanj, Odisha, India from June 2018 to January 2019. Results: In our study, 481(60.43%) patients had ischemic stroke and 315 (39.57%) patients had hemorrhagic stroke. The incidence of stroke is maximum in 51-70 years of age group which comprises of 59.46% of total patients. The average age + SD were 61.4±13.1 in our study. The most common risk factor was hypertension with 69.85% followed by dyslipidemia 51.77%. Most common clinical presentation was hemiplegia (72.35%) followed by speech involvement (59.46%). Most common site of infarct was parietal (22.25%), followed by periventricular (12.68%).Conclusions: Most of the patients had ischemic stroke as compared to hemorrhagic stroke. It was more common in males. The study contributes to understanding of demographic characteristics, risk factors, and stroke subtypes in acute ischemic stroke. The importance of various risk factors among ischemic stroke subtypes should be stressed for prompt preventive strategies and treatment.

The physiopathology of spontaneous hemorrhagic stroke: a systematic review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Alcivan Batista de Morais Filho ◽  
Thiago Luis de Holanda Rego ◽  
Letícia de Lima Mendonça ◽  
Sulyanne Saraiva de Almeida ◽  
Mariana Lima da Nóbrega ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Natural History ◽  
Hemorrhagic Stroke ◽  
Recent Literature ◽  
Clinical Manifestations ◽  
The Road ◽  
History Of

Abstract Hemorrhagic stroke (HS) is a major cause of death and disability worldwide, despite being less common, it presents more aggressively and leads to more severe sequelae than ischemic stroke. There are two types of HS: Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH), differing not only in the site of bleeding, but also in the mechanisms responsible for acute and subacute symptoms. This is a systematic review of databases in search of works of the last five years relating to the comprehension of both kinds of HS. Sixty two articles composed the direct findings of the recent literature and were further characterized to construct the pathophysiology in the order of events. The road to the understanding of the spontaneous HS pathophysiology is far from complete. Our findings show specific and individual results relating to the natural history of the disease of ICH and SAH, presenting common and different risk factors, distinct and similar clinical manifestations at onset or later days to weeks, and possible complications for both.

Patient Demographics, Characteristics, and Intrahospital Mortality of Different Ischemic Stroke Subtypes in a Tertiary Hospital during Five-Year Period

2021 ◽  
Vol 6 (1) ◽  
pp. 6
Author(s):  
Sintija Strautmane ◽  
Kristaps Jurjāns ◽  
Estere Zeltiņa ◽  
Evija Miglāne ◽  
Andrejs Millers
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Reperfusion Therapy ◽  
Cardioembolic Stroke ◽  
Study Group ◽  
Large Artery ◽  
Patient Demographics ◽  
Stroke Subtypes ◽  
Female Predominance ◽  
Study Population

Background and Objectives. Ischemic stroke (IS) is one of the leading causes of disability, morbidity, and mortality worldwide. The goal of the study was to evaluate patient demographics, characteristics, and intrahospital mortality among different ischemic stroke subtypes. Materials and Methods. A retrospective observational non-randomized study was conducted, including only ischemic stroke patients, admitted to Pauls Stradins Clinical university hospital, Riga, Latvia, from January of 2016 until December 2020. Ischemic stroke subtypes were determined according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria as a stroke due to (1) large-artery atherosclerosis (atherothrombotic stroke (AS)), (2) cardioembolism (cardioembolic stroke (CS)), (3) small-vessel occlusion (lacunar stroke (LS)), (4) stroke of other determined etiology (other specified stroke (OSS)), and (5) stroke of undetermined etiology (undetermined stroke (US)). The data between different stroke subtypes were compared. Results. There was a slight female predominance among our study population, as 2673 (56.2%) patients were females. In our study group, the most common IS subtypes were cardioembolic stroke (CS), 2252 (47.4%), and atherothrombotic stroke (AS), 1304 (27.4%). CS patients were significantly more severely disabled on admission, 1828 (81.4%), and on discharge, 378 (16.8%), p < 0.05. Moreover, patients with CS demonstrated the highest rate of comorbidities and risk factors. This was also statistically significant, p < 0.05. Differences between the total patient count with no atrial fibrillation (AF), paroxysmal AF, permanent AF, and different IS subtypes among our study population demonstrated not only statistical significance but also a strong association, Cramer’s V = 0.53. The majority of patients in our study group were treated conservatively, 3389 (71.3%). Reperfusion therapy was significantly more often performed among CS patients, 770 (34.2%), p < 0.05. The overall intrahospital mortality among our study population was 570 (12.0%), with the highest intrahospital mortality rate noted among CS patients, 378 (66.3%), p < 0.05. No statistically significant difference was observed between acute myocardial infarction and adiposity, p > 0.05. Conclusions. In our study, CS and AS were the most common IS subtypes. CS patients were significantly older with slight female predominance. CS patients demonstrated the greatest disability, risk factors, comorbidities, reperfusion therapy, and intrahospital mortality.

Abstract T P153: Women and Men with Ischemic Stroke in SiGN Have Different Subtype Distributions and Risk Factors

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kathryn M Rexrode ◽  
Braxton D Mitchell ◽  
Kathleen A Ryan ◽  
Steven J Kittner ◽  
Hakan Ay ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Cardioembolic Stroke ◽  
Relative Distribution ◽  
Large Artery ◽  
Stroke Risk Factors ◽  
Stroke Subtypes ◽  
Small Artery Occlusion ◽  
Ischemic Stroke Risk

Introduction: The relative distribution of stroke risk factors, as well as ischemic stroke subtypes, in women compared with men is not well described. Hypothesis: We hypothesized that the distribution of ischemic stroke risk factors and subtypes would differ by sex, with a later onset in women and greater proportion of comorbidities. Methods: The NINDS Stroke Genetics Network (SiGN) consortium was established to evaluate genetic risk factors for ischemic stroke. A total of 23 separate studies performed Causative Classification of Stroke (CCS) typing using standardized criteria on ischemic stroke cases and contributed data on risk factors. We compared the distribution of ischemic stroke risk factors and CCS phenotypes between men and women with ischemic stroke. Results: Of the 16,228 ischemic strokes in SiGN, 8005 (49.3%) occurred in women. Median age at stroke was older in female than male stroke cases (73 vs. 66 years) (p=<0.0001). Among stroke cases, women were more likely than men cases to have hypertension or atrial fibrillation and less likely to have diabetes or coronary artery disease, or to smoke (p <0.003 for all). The distribution of stroke subtypes also differed by sex, with women less likely than men to have large artery infarction and small artery occlusion, and more likely to have cardioembolic stroke and undetermined stroke due to incomplete work-up (p values all <0.0001; see Table). Results were similar when the distribution of stroke subtypes was examined for those <70 years and ≥70 years, except for cardioembolic stroke remaining more common only among women ≥70. Conclusions: In this large group of carefully phenotyped ischemic strokes, the distribution of ischemic stroke subtypes and risk factor profiles differ significantly by sex. Evaluation of the causes of these differences may highlight areas for improved prevention and risk reduction in both genders.

Abstract TP222: Frequency of Intracranial Arterial Imaging and its Yield in Consecutive Patients with Non-lacunar Cryptogenic Ischemic Stroke: ESUS Global Registry

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Kanjana S Perera ◽  
Balakumar Swaminathan ◽  
Jackie Bosch ◽  
Robert G Hart ◽  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Latin American ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Stroke Population ◽  
Atherosclerotic Stenosis ◽  
Index Stroke ◽  
Global Registry ◽  
Arterial Imaging

Background: Atherosclerotic stenosis of large IC arteries is an important cause of stroke. The prevalence of ICS in stroke population differs by ethnicity.We report the frequency of ICS among a global sample of patients with non-lacunar cryptogenic ischemic stroke (NLCIS) who did not have another identifiable cause for stroke i.e. cardioembolic, extracranial LAD, or other specific causes. Hypothesis: We hypothesized that the prevalence rates of ICS will differ according to global regions. Methods: Consecutive patients with recent ischemic stroke were retrospectively surveyed at 19 stroke centers in 19 countries to identify the frequency of IC imaging and its yield. Countries were grouped by World Bank regions. ICS was considered to be significant if there was >50% stenosis in the arteries proximal to the index stroke evidenced by MRA, CTA or TCD. Results: We identified a total of 2145 consecutive ischemic stroke patients among which 475 had NLCIS. IC arterial imaging was carried-out,on average, in 87% of patients. Of these 414 patients, 15% had stenosis proximal to the area of brain ischemia. The frequency of ICS among NLCIS patients was highest in East Asia (27%) and lowest in Pacific (4%). Patients with ICS in Latin America were significantly younger when compared to other 4 regions. Conclusion: IC arterial imaging is carried out in majority of stroke centers in patients with NLCIS, among whom the fraction of IS associated with ICS is substantial throughout the world, averaging about 15%. MRA / CTA had a higher yield than TCD. On average these patients have traditional vascular risk factors except for Latin American patients who are significantly younger with no vascular risk factors.

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