Circadian Variability in Pediatric Arterial Ischemic Stroke

Authors

• Sarah Lee, Stanford Stroke Center, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: slee10@stanford.edu.
• Anirudh Sreekrishnan, Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
• Michael Mlynash, Stanford Stroke Center, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
• Fernanda Balut, Department of Pediatric Neurology, San Borja Arriarán Hospital, University of Chile, Santiago, Chile.
• Rachel Pearson, Department of Pediatric Neurology, Rady Children's Health, Orange, CA, USA; Department of Pediatrics, University of California Irvine, Irvine, CA, USA.
• Dana B. Harrar, Department of Neurology, Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA.
• Sahar Hassanein, Department of Pediatrics, Division of Pediatric Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
• Taryn L. Surtees, Department of Pediatric Neurology, University of Michigan Health, Ann Arbor, MI, USA.
• Janette Mailo, Division of Pediatric Neurology, Department of Pediatrics, University of Alberta, Alberta, Canada.
• Nomazulu Dlamini, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontaria, Canada.

Document Type

Journal Article

Publication Date

2-1-2026

Journal

The Journal of pediatrics

Volume

289

DOI

10.1016/j.jpeds.2025.114875

Keywords

circadian rhythm; large vessel occlusion; perfusion imaging

Abstract

OBJECTIVE: To assess whether the timing of ischemic stroke onset demonstrates circadian variability in children. STUDY DESIGN: We performed a retrospective cohort study evaluating children with arterial ischemic stroke and known time of stroke onset who were enrolled in a large, multicenter pediatric stroke registry. Clinical and radiographic features were compared according to 4 time epochs-6:00-11:59 (morning), 12:00-17:59 (afternoon), 18:00-23:59 (evening), and 00:00-5:59 (night)-using Kruskal-Wallis and chi-square tests. Pairwise comparisons were conducted when needed. RESULTS: A total of 478 patients were included, with 54% male and a mean age of 9.9 ± SD 5.7 years. We observed a rise in stroke frequency in the morning that plateaued around 10:00, with a sustained high frequency into the early afternoon; most strokes occurred in the afternoon (n = 185, 38.7%), followed by the morning (n = 156, 32.6%). Arteriopathy risk factors were more prevalent in nighttime strokes (23/36, P = .034). Patients in the <2, 2-5, and 6-11-year-old age groups had a higher proportion of strokes in the afternoon (42%, 38%, and 45%, respectively). There was a trend for better median 6-month pediatric stroke outcome measure scores after evening strokes (0.5, IQR 0-1.5) compared with morning strokes (1, IQR 0.5-2) and afternoon strokes (1, IQR 0.5-3), P = .033, but this was not statistically significant after adjustment for multiple comparisons. CONCLUSIONS: Circadian influence on stroke timing appears to differ between adults and children. These findings could influence stroke systems of care and treatment strategies for pediatric stroke.

APA Citation

Lee, Sarah; Sreekrishnan, Anirudh; Mlynash, Michael; Balut, Fernanda; Pearson, Rachel; Harrar, Dana B.; Hassanein, Sahar; Surtees, Taryn L.; Mailo, Janette; and Dlamini, Nomazulu, "Circadian Variability in Pediatric Arterial Ischemic Stroke" (2026). GW Authored Works. Paper 8766.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8766

Department

Neurology