Stroke topography and outcome in relation to hyperglycaemia and diabetes.

Abstract

In a prospective study to analyse stroke topography and outcome in diabetics and to determine the prognostic value ofblood glucose and glycosylated haemoglobin estimation, we evaluated 176 patients with acute stroke. The patients were classified into four groups on the basis of history, fasting glucose, and glycosylated haemoglobin: euglycaemic patients with no history of diabetes, stress hyperglycaemia, newly diagnosed diabetics, and known diabetics. A high prevalence of undiagnosed diabetes was shown. No difference was found in the type or site of stroke between the four groups. No difference was found in the site of symptomatic or incidental lesions on computerised axial tomography. Patients with stress hyperglycaemia and known diabetics had more severe strokes. Mortality was higher in patients with stress hyperglycaemia, newly diagnosed diabetics, and the combined diabetes groups. This increased mortality was evident in the hyperglycaemic and diabetic groups, even after excluding patients with cerebral haemorrhage. Stroke severity and mortality also increased independently with blood glucose in the euglycaemic group. We conclude that there is a correlation between admission glucose concentration, diabetes, and poor stroke outcome, which may not be attributed to stroke type or location.Epidemiological and necropsy studies show that diabetic patients have a higher incidence of ischaemic stroke than non-diabetic patients.' 2 In the Framingham study the incidence of thrombotic stroke was 2-5 times higher in diabetic men and 3-6 times higher in diabetic women than in those without diabetes.3 Wolf and Kannell reported that even when other risk factors such as hypertension and ischaemic heart disease are taken into account diabetes remains an independent risk factor for stroke.4 Previous studies have found a range of prevalence of undiagnosed diabetes in acute stroke populations from 6%' to 42%6.The type and topography of diabetes-related cerebral infarction may differ from brain infarcts in non-diabetics. In a necropsy survey Kane and Aronson7 found that diabetics had more lacunar lesions when compared with non-diabetics, especially in the distribution of the parasagittal perforating arteries. Peress et al8 also reported a higher occurrence of lacunar infarcts in diabetics compared with non-diabetic patients. In the Harvard cooperative stroke registry,9 hypertension and diabetes were present respectively in 75% and 29% of lacunar cases and 71% and 43% of cases in the South Alabama population study.'o Several animal studies of experimental cerebral ischaemia have shown that hyperglycaemia increases the severity of ischaemic brain dam-

Stroke in patients with diabetes mellitus: A study from Northwestern Nigeria

“…A lower frequency of hemorrhagic stroke recorded in this study was in agreement with a lower frequency of intracerebral hemorrhages in diabetic patients observed by Lithner et al 33 and by Kiers et al 34 Unlike for chronic hypertension and hemorrhagic stroke, most case control studies examining the relationship between DM and hemorrhagic stroke have not concluded that DM is an independent risk factor for both intracerebral and subarachnoid hemorrhagic stroke.…”

“…This finding is consistent with Copenhagen stroke studies which showed that there was no relation between admission blood glucose levels and mortality. 19 A similar finding has also been reported from studies conducted elsewhere, 34,40 however, very few studies demonstrated an increased mean glucose level and mortality in diabetic patients. 33 Nonetheless, in non-diabetic patients with stroke, several [41][42] but few have found an increased mortality in hyperglycemic non-diabetic patients compared with euglycemic non-diabetic patients.…”

Management of blood glucose in patients with stroke

“…Several aspects of physiology, notably blood pressure, body temperature, blood oxygen saturation, and blood glucose, may be altered after an ischaemic stroke or an intracerebral hemorrhage. Patients with acute ischaemic stroke frequently test positive for hyperglycaemia, which is associated with a poor clinical outcome [2][3][4]. Most studies showed the deleterious effect of early hyperglycaemia, especially in patients with nonlacunar focal or global ischaemia [5].…”

Acute Ischemic Stroke Management Review for the Hospitalist

“…Increased mortality was evident in the hyperglycemic and diabetic groups (104). Hyperglycemia is associated with lactic acidosis and conversion of penumbral tissue to an infarction, greater final infarct size, and worse functional outcome (104).…”