Relationship between stroke onset timing and clinical outcomes in ischemic and hemorrhagic strokes - systematic review

Sep 29, 2026

A systematic review examines how the timing of stroke onset relates to patient outcomes in both ischemic and hemorrhagic strokes. Cerebrovascular accident (CVA) is presented as a critical condition driven by interrupted cerebral blood flow and severe neurodegeneration, with CVAs classified into ischemic and hemorrhagic types. Using MeSH-based searches across major databases, the review synthesizes observational evidence on risk by daytime, then summarizes circadian patterns and severity associations to inform prevention, treatment management, and outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages27

Reading Time1 h 8 min

AccessFree to download

Background

Methods

Results

Conclusion

International Journal of Cardiology Cardiovascular Risk and Prevention 28 (2026) 200559 Contents lists available at ScienceDirect International Journal of Cardiology Cardiovascular Risk and Prevention journal [homepage:](homepage: www.journals.elsevier.com/international-journal-of-cardiology)[ www.journals.elsevier.com/international-journal-of-cardiology](homepage: www.journals.elsevier.com/international-journal-of-cardiology)cardiovascular-risk-and-prevention | Relationship between stroke onset timing and clinical outcomes in ischemic and hemorrhagic strokes: a systematic review
Paria Heidaria, Negar Heidarib, Habibolah Khazaiec, Sabra Margaret Abbott d, Azad Maroufie, Amir Abdolmalekif, Nader Salarig, Masoud Mohammadi h,* , Amir Sharafkhanehi,**
a Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
b Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran c Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
d Northwestern Feinberg, School of Medicine, Chicago, IL, USA
e Neurosciences Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran f Department of Operating Room, Nahavand School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran g Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran h Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
i Department of Medicine, Pulmonary, Critical Medicine and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA | | | | --- | --- | --- | | A R T I C L E I N F O | | A B S T R A C T | | Keywords:
Stroke outcomes Ischemic stroke Hemorrhagic stroke Systematic review | | Background: Cerebrovascular accident (CVA) is a critical medical pathology caused by the interruption of cerebral blood flow and leads to neuronal injury or neurodegeneration. Generally, CVAs are classified into two primary categories of ischemic and hemorrhagic. Investigation of circadian rhythm variation at the time of CVA onset is a critical subject for patient management, clinical treatment, and further scientific research. This systematic review aimed to investigate the relationship between the timing of stroke onset and patient outcomes in both ischemic and hemorrhagic strokes.
Methods: Following searching strategy designation, international databases of Embase, PubMed, Scopus, WoS, ScienceDirect, and Google Scholar were searched using the MeSH-based keywords. No time restrictions were applied in this regard (by December 8, 2024). All English-based observational studies reporting the risk of CVA at various daytimes were enrolled for screenings and quality control. Finally, eligible studies were selected for data extraction and categorization.
Results: According to the reports, ischemic strokes strictly occur in morning hours (06:00 to 12:00) while some studies recorded a bimodal pattern (dual peaks during morning and evening). It was also established that the strokes at night were more severe and yielded more unfavorable results. Scattered reports were found regarding the hemorrhagic strokes; some papers revealed the highest incidence in the early morning hours, while others reported the late evening or nighttime occurrence. In addition, some studies showed that nighttime hemorrhagic strokes are usually associated with greater severity and unfavorable clinical outcomes.
Conclusion: This study clarified the effect of cyclic pattern on the incidence and outcome of stroke. These trends seem greatly accounted for improvement of prevention strategies, management of treatments, and enhancement of patient outcomes. | 1. Background Cerebrovascular accident (CVA) is a critical medical condition caused by the interruptio

FAQs

What is the main goal of this systematic review?

To investigate the relationship between the timing of stroke onset and clinical outcomes in both ischemic and hemorrhagic strokes.

Which studies and databases were searched for the review?

Embase, PubMed, Scopus, WoS, ScienceDirect, and Google Scholar were searched using MeSH-based keywords, with no time restrictions up to December 8, 2024.

What circadian pattern was reported for ischemic stroke onset?

Ischemic strokes were reported to occur strictly in morning hours (06:00 to 12:00), with some studies showing a bimodal pattern with dual peaks in the morning and evening.

How did night-time strokes relate to severity and outcomes?

Night-time strokes were reported as more severe and associated with more unfavorable results, including for hemorrhagic strokes in several studies.

Sep 29, 2026

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