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Hyperglycemia in acute ischemic stroke: pathophysiology and clinical management
Nyika D Kruyt1, Geert Jan Biessels, J Hans Devries
1Department of Neurology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands. n.d.kruijt@amc.uva.nl
Nature Reviews. Neurology
|February 17, 2010
Summary
Hyperglycemia, or high blood sugar, is common in acute ischemic stroke and linked to worse outcomes. This review examines evidence and strategies for managing blood sugar in stroke patients to improve prognosis.
Area of Science:
- Neurology
- Endocrinology
- Critical Care Medicine
Background:
- Hyperglycemia is frequently observed in acute ischemic stroke patients.
- Poor glycemic control correlates with unfavorable prognosis, especially in persistent hyperglycemia, non-diabetic patients, and cortical infarction.
- Existing clinical evidence on glycemic control's impact on stroke outcomes is limited, with one trial showing no benefit.
Purpose of the Study:
- To review the evidence linking hyperglycemia to poor outcomes in ischemic stroke.
- To explore pathophysiological mechanisms of hyperglycemia's detrimental effects.
- To systematically review literature on tight glycemic control post-stroke and provide treatment strategy directions.
Main Methods:
- Systematic literature review of studies on hyperglycemia and ischemic stroke outcomes.
- Analysis of pathophysiological mechanisms.
- Review of clinical trials and guidelines regarding glycemic control in stroke.
Main Results:
- Hyperglycemia is consistently associated with poorer clinical outcomes in ischemic stroke.
- International guidelines recommend hyperglycemia treatment despite limited supporting evidence.
- Glycemic control in stroke patients is challenging and carries a risk of hypoglycemia.
Conclusions:
- Further research is needed to clarify the role and optimal management of hyperglycemia in acute ischemic stroke.
- Evidence suggests a link between hyperglycemia and poor stroke prognosis, necessitating careful consideration of treatment strategies.
- Developing safe and effective insulin treatment strategies is crucial for managing hyperglycemia in this patient population.
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