Related Experiment Videos
Blood glucose, glycosylated haemoglobin, and outcome of ischemic brain infarction
K Murros1, R Fogelholm, S Kettunen
1Department of Neurology, Central Hospital of Central Finland, Jyväskylä.
Insights
High fasting blood glucose levels after a stroke may indicate a more severe brain injury, not necessarily pre-existing diabetes. Post-stroke glucose levels in non-diabetics correlate with stroke severity and outcome.
Area of Science:
- Neurology
- Endocrinology
- Medical Research
Background:
- Recent brain infarction in the carotid territory affects conscious patients under 70.
- Assessing blood glucose and glycosylated hemoglobin (HbA1c) is crucial for stroke patients.
- Stroke severity, functional outcome, and infarct volume are key metrics.
Purpose of the Study:
- To investigate the relationship between prestroke glucose levels and stroke outcomes.
- To determine if fasting blood glucose predicts stroke severity and functional outcome.
- To differentiate between stress-induced hyperglycemia and pre-existing diabetic hyperglycemia post-stroke.
Main Methods:
- Prospective study of 99 patients with recent carotid territory brain infarction.
- Fasting blood glucose and HbA1c measured within 48 hours of symptom onset.
- Assessment of hemiparesis, functional outcome, and infarct volume via CT scans.
Main Results:
- No significant difference in outcomes between normoglycemic and hyperglycemic groups based on HbA1c.
- Fasting blood glucose in non-diabetics strongly correlated with hemiparesis severity and predicted stroke outcome.
- Blood glucose levels correlated with cortical infarct volumes in non-diabetics.
Conclusions:
- High fasting blood glucose post-stroke in non-diabetics reflects a stress response to ischemic brain lesions.
- Prestroke blood glucose levels do not predict stroke outcome.
- Distinguishing stress hyperglycemia from pre-existing hyperglycemia is vital for accurate stroke assessment.
Abstract:
From August 1987 through December 1989 all consecutive conscious patients younger than 70 years with a recent (less than 48 h) brain infarction of the carotid territory were prospectively included in the study. Blood samples for fasting blood glucose and glycosylated haemoglobin (HbA1c) were taken after a median delay of 23 h of the onset of symptoms. The severity of hemiparesis was assessed on admission, at 1 week, 3 weeks, and 3 months. The functional outcome was assessed at 3 months. Computed cerebral tomography was performed on admission, and later on at 3 weeks or 3 months. The brain infarct volume was measured from the CTs. The patients were diagnosed to have prestroke normoglycemia (n = 76) and prestroke hyperglycemia (n = 23) on basis of the HbA1c level. The case fatality rate, severity of hemiparesis, functional outcome, and infarct size did not differ between these 2 groups. On the other hand, fasting blood glucose level of the non-diabetics correlated strongly with the severity of hemiparesis and predicted stroke outcome. A statistically significant correlation was observed between blood glucose values and the volumes of cortical infarcts in non-diabetics. Because prestroke blood glucose level, in contrast to post-stroke blood glucose level, did not have any predictive value concerning stroke outcome it is concluded that high fasting blood glucose values after stroke reflect a stress response to a more severe ischemic brain lesion.