The effect of admission hyperglycemia in stroke patients treated with thrombolysis.
ABSTRACT ABSTRACT Background: Acute hyperglycemia (HG) has been shown to correlate negatively with an outcome in stroke patients, yet the mechanism remains controversial. The aim of our study is to study the immediate and long-term effects of admission HG on outcome in a cohort of stroke patients treated with thrombolytic therapy. Methods: We reviewed the prospective dataset of a statewide telestroke network for the characteristics of 195 patients who received intravenous tissue plasminogen activator via telemedicine during a 27-month period. We compared outcome and improvement rate of patients with and without HG. We defined good outcome as a modified Rankin Scale score ≤ 2 and neurological improvement after thrombolysis as either a decrease in National Institutes of Health Stroke Scale (NIHSS) at 24 hr by 5 points from baseline or an NIHSS of 0 at 24 hr. Results: Thirty-one percent of patients had admission HG (Blood sugar > 144). Patients with admission HG had higher 3-month mortality and poor outcome rates than those without normoglycemia (NG). The improvement rates with thrombolysis, however, were similar between the two groups. Conclusions: Admission HG is associated with poor neurological recovery in patients with an acute stroke despite thrombolytic treatment without having an effect on the clinical response to thrombolytic therapy. Larger studies are needed to confirm this finding.
- Stroke 06/2003; 34(5):1235-41. · 6.16 Impact Factor
- Stroke 03/2012; 43(3):898-902. · 6.16 Impact Factor
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ABSTRACT: Acute poststroke hyperglycemia has been associated with larger infarct volumes and a cortical location, regardless of diabetes status. Stress hyperglycemia has been attributed to activation of the hypothalamic-pituitary-adrenal axis but never a specific cortical location. We tested the hypothesis that damage to the insular cortex, a site with autonomic connectivity, results in hyperglycemia reflecting sympathoadrenal dysregulation. Diffusion-weighted MRI, glycosylated hemoglobin (HbA1c), and blood glucose measurements were obtained in 31 patients within 24 hours of ischemic stroke onset. Acute diffusion-weighted imaging (DWI) lesion volumes were measured, and involvement of the insular cortex was assessed on T2-weighted images. Median admission glucose was significantly higher in patients with insular cortical ischemia (8.6 mmol/L; n=14) compared with those without (6.5 mmol/L; n=17; P=0.006). Multivariate linear regression demonstrated that insular cortical ischemia was a significant independent predictor of glucose level (P=0.001), as was pre-existing diabetes mellitus (P=0.008). After controlling for the effect of insular cortical ischemia, DWI lesion volume was not associated with higher glucose levels (P=0.849). There was no association between HbA1c and glucose level (P=0.737). Despite the small sample size, insular cortical ischemia appeared to be associated with the production of poststroke hyperglycemia. This relationship is independent of pre-existing glycemic status and infarct volume. Neuroendocrine dysregulation after insular ischemia may be 1 aspect of a more generalized acute stress response. Future studies of poststroke hyperglycemia should account for the effect of insular cortical ischemia.Stroke 09/2004; 35(8):1886-91. · 6.16 Impact Factor