Circadian rhythm of ischaemic core progression in human stroke

You will soon need to have the stroke at the correct time along with having the classic stroke symptoms so you get diagnosed correctly as having a stroke. Your responsibility, not your doctor's responsibility to have the protocols in place to treat any size stroke at any time. You don't want to burden your doctors with having to prepare for any stroke eventuality.

 Circadian rhythm of ischaemic core progression in human stroke

1. Paul Reidler1,
2. Alex Brehm2,
3. Peter B. Sporns2,3,
4. Vanessa Granja Burbano4,
5. Lena Stueckelschweiger1,
6. http://orcid.org/0000-0002-7575-9850Gabriel Broocks3,
7. Thomas Liebig5,
8. Marios-Nikos Psychogios2,
9. Jens Ricke1,
10. Konstantinos Dimitriadis4,6,
11. Martin Dichgans4,7,8,
12. Wolfgang G. Kunz1,
13. http://orcid.org/0000-0002-8817-8457Steffen Tiedt4,8

1. Correspondence to Dr Steffen Tiedt, Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; steffen.tiedt@med.uni-muenchen.de

Abstract

Introduction Experimental stroke studies suggest an influence of the time of day of stroke onset on infarct progression. Whether this holds true after human stroke is unknown, but would have implications for the design of randomised controlled trials, especially those on neuroprotection.

Methods We pooled data from 583 patients with anterior large-vessel occlusion stroke from three prospectively recruited cohorts. Ischaemic core and penumbra volumes were determined with CT perfusion using automated thresholds. Core growth was calculated as the ratio of core volume and onset-to-imaging time. To determine circadian rhythmicity, we applied multivariable linear and sinusoidal regression analysis adjusting for potential baseline confounders.

Results Patients with symptom onset at night showed larger ischaemic core volumes on admission compared with patients with onset during the day (median, 40.2 mL vs 33.8 mL), also in adjusted analyses (p=0.008). Sinusoidal analysis indicated a peak of core volumes with onset at 11pm. Core growth was faster at night compared with day onset (adjusted p=0.01), especially for shorter onset-to-imaging times. In contrast, penumbra volumes did not change across the 24-hour cycle.

Discussion These results suggest that human infarct progression varies across the 24-hour cycle with potential implications for the design and interpretation of neuroprotection trials.

http://dx.doi.org/10.1136/jnnp-2021-326072