Abstract
The correlation of glycemic status to clinical severity and outcome of cerebrovascular accident (CVA) was studied in newly diagnosed CT/MRI proven cases of stroke. Total 200 patients were classified into euglycemia, stress hyperglycaemia and diabetic group based on the admission blood glucose, glycosylated haemoglobin (HbA1C) and past history of diabetes. The lesions (bleed/infarct) were classified into small, medium and large sized. Neurological assessment was done on admission using National Institute of Health Stroke Scale (NIHSS) score and the patients were followed up for 7 days to see the outcome. The maximum number of patients were between age groups of 61-70 constituting 39.5% of the total, with M: F 1.3:1, The incidence of hyperglycaemia was 58% and admission blood glucose ranged between 70-576 mg%. There were 35.5 % patients with diabetes, 22.5% with stress hyperglycemia and 42 % with euglycemia. Increased admission glucose was associated with severe presentation, high NIHSS scores and higher mortality among ischemic stroke. Admission blood glucose did not correlate with the severity and outcome in haemorrhagic stroke suggesting that admission blood glucose is not an independent predictor of severity and outcome in haemorrhagic stroke.
Keywords: glycemic status, stress hyperglycaemia, diabetes, cerebrovascular accident, ischemic stroke, haemorrhagic stroke, HbA1C, NIHSS.
References
- Wade S Smith, S Clairborne Johnston, J Claude Hemphill- Cerebrovascular diseases,19th edition Harrison’s Principles of Internal Medicine,McGraw Hill medical publishers, Editors- Anthony S Fauci, Eugene Braunwald, Dennis L Kasper, Stephen L Hauser, Dan L Longo, J Larry Jameson, Joseph Loscalzo. vol 2.pp2259
- World Stroke Day 2009. Articles published in India, Brain stroke third largest killer in India, http://beta.thehindu.com/health/policy and issues/ article 40507.ece
- Association between diabetes and stroke subtype on survival and functional outcome 3 months after stroke: Data from the European BIOMED Stroke Project. 2003;34:688-694.
- Candelise L, Landi G, Boccardi E ,et.al, Prognostic significance of hyperglycemia in acute stroke, Arch Neurol 1985;42:661-663.
- Weir CJ, Murray G D, Dyker AG, Lees KR, Is hyperglycemia an independent predictor of poor outcome after acute stroke. Results of long term follow up, BMJ 1997; 314:1303-06.
- Bruno A, Biller J, Adams HP Jr, Clarke WR, Woolson RF, Williams LS, Hansen MD. Acute blood glucose level and outcome from ischemic stroke. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Neurology 1999; 52:280– 284.
- Frontera JA, Fernandez A, Claassen J, Schmidt M, Schumacher C, Wartenberg K, et al. Hyperglycemia After SAH: Predictors, Associated Complications, and Impact on Outcome. Stroke journal of American heart association Stroke 2006; 37: 199-203.
- K Ghanachandra Singh et al.A study on the clinical profile of stroke in relation to glycemic status of patients.JIACM 2014;15(3-4):177-181
- Bonita R et al: American Journal of Epidemiology,120:236-43,1984
- Mankowsky BN et al: Cerebrovascular disorders in patients with DM. Journal of Diabetes complications, July 1996,228-42.
- Perttu J. Lindsberg, MD, PhD; Risto O. Roine, MD, PhD Hyperglycemia in Acute Stroke .Stroke 2004; 35:363-364.
- Baird TA, Parsons MW, Barber PA, Butcher KS, Desmond PM, Tress BM, Colman PG, Jerums G, Chambers BR, Davis SM. The influence of diabetes and hyperglycemia on stroke incidence and outcome. J Clin Neurosci. 2002;9:618-626.
- L Kiers, SM Davis, R Larkins-Stroke topography and outcome in relation to hyperglycemia and diabetes. Journal of Neurology, Neurosurgery, and Psychiatry 1992;55:263-270
- Sunanda et al (2016) Role of HbA1c at admission on severity & functional outcome of ischemic stroke in patients with diabetes mellitus. J.Neurology Neurophysiology 7:377
- Helgason CM. Blood glucose and stroke. Stroke 1988;19:1049-53.
- R N Sarkar, Samar Banerjee, ABasu. Comparative evaluation of Diabetic and non-diabetic stroke –effect of glycemia on outcome. JIMA. 2004;102(10):551- 553.
- Weir CJ, Murray G D, Dyker AG, Lees KR, Is hyperglycemia an independent predictor of poor outcome after acute stroke. Results of long term follow up, BMJ 1997; 314:1303-06.
- Lakshman I et al.Front Neurol.2018;9:725.
- Power MJ, Fullerton KJ, Stout RW. Blood glucose and prognosis of acute stroke. Age Ageing1988; 17: 164-70.
- Chambers BR, Norris JW, Shurvell, BL, Hachinski VC. Prognosis of acute stroke. Neurology 1987;37:221-5.
- Masaru Sakurai et al, Diabetes Care.2013 Nov;36(11):3759-3765
Corresponding Author
Dr Prachi Pratichi Das, Post Graduate
Medicine, VSSIMSAR