Trigger Factors of Acute Stroke: A Case-Crossover Study

Compared to traditional chronic risk factors, our understanding of trigger factors for acute stroke remains relatively limited. This study aimed to identify common trigger factors associated with acute stroke onset and to determine whether exposure to these triggers differs across age groups. Using a case-crossover design, we compared each patient’s exposures during the case period (hazard period) with their exposures during the control period. By analyzing the differences between trigger periods (acute exposure windows) and stable periods (baseline), we identified potential stroke triggers. Furthermore, we examined whether exposure patterns varied across different age groups. The study included 248 acute stroke patients (mean age 58.1±16.6 years; 141 males [56.8%]). Significant triggers included Valsalva maneuvers (OR=3.52, 95%CI=2.16-5.74), strenuous exercise (OR=2.47, 95%CI=1.56-3.92), sudden change of position (OR=2.93, 95%CI=1.82-4.74), temperature changes (OR=2.86, 95%CI=1.77-4.61), satiation (all levels), and anger intensity (all levels). Notably, no significant differences were observed in exposure to all investigated trigger factors across age groups. These findings provide novel insights into the pathophysiology of cerebral thrombosis and offer evidence-based guidance for targeted acute stroke prevention strategies.