TY - JOUR T1 - Circadian rhythm of ischaemic core progression in human stroke JF - Journal of Neurology, Neurosurgery & Psychiatry JO - J Neurol Neurosurg Psychiatry DO - 10.1136/jnnp-2021-326072 SP - jnnp-2021-326072 AU - Paul Reidler AU - Alex Brehm AU - Peter B. Sporns AU - Vanessa Granja Burbano AU - Lena Stueckelschweiger AU - Gabriel Broocks AU - Thomas Liebig AU - Marios-Nikos Psychogios AU - Jens Ricke AU - Konstantinos Dimitriadis AU - Martin Dichgans AU - Wolfgang G. Kunz AU - Steffen Tiedt Y1 - 2021/05/25 UR - http://jnnp.bmj.com/content/early/2021/07/14/jnnp-2021-326072.abstract N2 - 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. ER -