[Hyperglycemia: a predictor of poor prognosis in acute stroke]

Hyperglycemia is common and involves up to 50% of the acute stroke patients. Several clinical studies have revealed that hyperglycemia is associated with a poor outcome in terms of mortality and neurological recovery. The results obtained from experimental studies have shown that hyperglycemia exacerbates the ischemic lesions and is associated with an increase of the edema and size of the infarct, as well as a decrease in the cerebral blood flow. In contradiction with animal models no increase in hemorrhagic transformation of the brain infarct after reperfusion is observed among patients with hyperglycemia, unless they are treated with rt-PA. Elevated plasma glucose levels (glycemia > 8 mmol/L) predict poor prognosis, irrespective of age, severity, or stroke sub-type. The benefit to treat a glycemia >=11 mmol/l has been established in terms of mortality for patients with myocardial infarction. Although the clinical benefit of plasma glucose lowering therapy remains unknown regarding acute stroke, based on current evidence, we recommend to treat moderate to mild hyperglycemia with glucose potassium insulin infusions.