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August 1991

Circadian Variation in Stroke

Author Affiliations

Division of Neurology Stroke Acute Care Unit Duke University Medical Center Box 3392 Durham, NC 27710

Arch Neurol. 1991;48(8):790. doi:10.1001/archneur.1991.00530200026011

To the Editor.  —I was intrigued by the article by Marsh et al1 published in the November 1990 issue of the Archives. If their findings of a circadian variation in stroke onset are verified, it might suggest new avenues of research to identify precipitating factors for stroke. However, I would like to raise some concerns about the data presented in their article.The correct establishment of exact times of onset of stroke symptoms can be exceedingly difficult. During the course of participating in several clinical stroke trials, my colleagues and I became acutely aware of the uncertainties associated with defining the time of symptom onset. We found that only after repeated questioning of the patient and family members were we able to establish a reasonably consistent time of onset. Several scenarios were seen frequently, such as patients who awoke but remained in bed for 1 or more hours before

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