Management of Hyperglycemia in Acute Stroke

Hyperglycemia and the Fate of Apparent Diffusion Coefficient–Defined Ischemic Penumbra

“…The study also confirms that strict baseline NG may protect the fate of at-risk tissue. Insulin therapy has not yet proved to be effective therapy [27][28][29][31][32][33][34] for acute stroke patients based on clinical end points assessments. Therefore, the ADC-based method could be used to study the effect of insulin therapy on smaller groups of patients, where end points are not solely dependent on clinical scales, 35,36 thus obviating the confounding effects of functional specialization of different brain regions.…”

“…26 This threshold value is within the range of the 6.1-8 mmol/L thresholds used for defining poststroke HG in several recent studies. 2,[8][9][10][11]27,28 We compared clinical, baseline, and final imaging data, including the amount of "spared tissueat-risk," defined as the difference between predicted and observed infarct growth in each patient, between the 2 groups. Our hypothesis was as follows: if the ADC-defined tissue-at-risk is part of the penumbra, HG patients would have higher observed infarct growth and smaller amount of spared tissue-at-risk.…”

Response of Blood Pressure and Blood Glucose to Treatment With Recombinant Tissue-Type Plasminogen Activator in Acute Ischemic Stroke

“…5,6 Such elevations are associated with greater risks of stroke morbidity and mortality 1,4,7 ; however, the benefits of modulating these parameters acutely remain controversial with randomized trial data not demonstrating a clear benefit. 2,8 It remains unclear whether these elevations are causally related to poorer outcomes. 1,2,8,9 It has been suggested that these elevations may represent a stress response secondary to the acute neurological deficit.…”

“…2,8 It remains unclear whether these elevations are causally related to poorer outcomes. 1,2,8,9 It has been suggested that these elevations may represent a stress response secondary to the acute neurological deficit. 2,8,9 Were this to be the case, elevations in BP and blood glucose would settle with reperfusion and improving neurological status.…”

“…1,2,8,9 It has been suggested that these elevations may represent a stress response secondary to the acute neurological deficit. 2,8,9 Were this to be the case, elevations in BP and blood glucose would settle with reperfusion and improving neurological status. Patients treated with recombinant tissue-type plasminogen activator (rtPA) within 4.5 hours of the onset of symptoms have better functional outcomes than controls 10 -12 due to clot lysis and reperfusion of the ischemic penumbra.…”