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Patients Who First Note Stroke Symptoms Upon Awakening Most Often Have Lacunar Strokes: Presented at ESC

By Bruce Sylvester
Special to DG News

GENEVA, SWITZERLAND -- June 3, 2002 -- In patients who first notice their stroke symptoms upon awakening, lacunar stroke is the most prevalent stroke diagnosis, researchers reported here Saturday at the European Stroke Conference (ESC).

People who have a morning stroke, however, have a low risk of having an intracerebral haemorrhage, the researchers found.

Based on previous studies, which described a circadian pattern of stroke onset for the different stroke subtypes, researchers from the hospital of the Athens University School of Medicine in Greece examined the etiology of stroke in patients who had first noticed their symptoms on awakening.

Led by K. Spengos, MD, professor of neurology, they tracked a consecutive cohort of 1253 patients diagnosed and admitted for strokes at their institution, classifying each stroke diagnosis with the criteria of the Athens Stroke Registry.

They found that patients or relatives noted symptoms of stroke at the time of awakening in 133 of the 1253 patients (10.6 percent). While gathering their data, the investigators presumed equal incidence of the five defined stroke subtypes. They examined subtype frequency using c² "goodness to fit" techniques and 95 percent confidence intervals.

They found that lacunar stroke was the diagnosis in 60 of the 133 cases (45.1 percent). Large vessel disease as the cause of stroke and cardioembolic stroke were diagnosed in 21 (15.8 percent) and 18 (13.5 percent) patients, respectively. Twenty-nine strokes (21.8 percent) were classified as undetermined or unusual. Five (3.8 percent) of those 133 patients whose symptoms had been noticed upon awakening were diagnosed with intracerebral haemorrhage.

Diagnosis distribution differed significantly from the assumed equal distribution in all five stroke subgroups (c²=63, 65; df=4; p<0.001).

"This study has led us on further research on the relationship between circadian patterns, their effects on changes in blood pressure and the resulting effects on stroke and type of stoke suffered," Dr. Spengos said.

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