Ischemic volumes and early neurologic deterioration in acute brainstem infarctions with hemoglobin A1c

To investigate the association of hemoglobin A1c (HbA1c) with acute diffusion-weighted imaging lesion volumes (DIV) and early neurologic deterioration (END) in brainstem infarctions (BSIs).

152 patients with acute BSIs were included in this study. The relationship between HbA1c and DIV quartiles was examined. Data considered potentially associated with HbA1c and END after admission and patients' symptomatic changes prior to admission were collected.

There was a significant correlation between HbA1c (%) and DIV (Spearman ρ=0.201, p=0.013). The median HbA1c (%) values for successive DIV quartiles (lowest to highest quartile) were as follows: 5.90, 6.35, 6.25, and 7.50 (p=0.033). The incidence of diabetes mellitus had a significant association with DIV quartiles (p=0.042). HbA1c was significantly associated with symptomatic progression prior to admission (p=0.015). 29 patients developed END after admission. Age, HbA1c, systolic blood pressure, and fibrinogen were significantly associated with END. On logistic regression analysis, HbA1c and fibrinogen proved to be independent variables.

HbA1c may be a possible predictor for ischemic severity, early deterioration of acute BSIs, and short-term prognosis. Long-term good glycemic control is very important in BSIs. Further studies are warranted to confirm these results.