THE RELATIONSHIP OF HYPERGLYCEMIA AND STROKE

INA JULIA SARI 030.07.114

HYPERGLYCEMIA
Hyperglycemia is the high blood sugar (glucose) level. High blood glucose happens when the body has too little insulin or when the body can not use insulin properly.

PATHOGENESIS

THE SYMPTOMS
THE CLASSIC SYMPTOMS
Polyphagia (frequently hungry) Polyuria (frequently urinating) Polydipsia (frequently thirsty)

DIAGNOSIS
Classic symptoms, weight loss, and random plasma glucose 200 mg/dL Fasting plasma glucose 126 mg/dL Two hours post glucose load (75 gr) plasma glucose 200 mg/dL, and confirmed by repeat test.

TREATMENT
The goals of treatment is lifestyle changes, blood sugar control, and medication treatment.

PROGNOSIS
Cardiovascular disease is the major source of mortality in patients with type 2 diabetes mellitus.

STROKE
Stroke is the clinical term for acute loss of perfusion to vascular territory of the brain, resulting in ischemia and a corresponding loss of neurologic function

PATHOGENESIS
Ischemic strokes result from events that limit or stop blood flow, such as embolism, thrombosis in situ, or relative hypoperfusion. As blood flow decreases, neurons cease functioning, and irreversible neuronal ischemia and injury begin at blood flow rates of less than 18 mL/100 mg/min. Within seconds to minutes of the loss of glucose and oxygen delivery to neurons, the cellular ischemic cascade begins. This is a complex process that begins with cessation of the normal electrophysiologic function of the cells. The resultant neuronal and glial injury produces edema in the ensuing hours to days after stroke, causing further injury to the surrounding tissues.

SIGN AND SYMPTOMS

Symptoms of stroke depend on the amount of blood involved and location of the stroke area in the brain, there are include :
Sudden numbness or weakness of the face, arm or leg (especially on one side of the body) Sudden confusion, trouble speaking or understanding speech Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance or coordination Sudden severe headache with no known cause

TEST AND DIAGNOSIS

Stroke is diagnosed through several techniques such as : Family members may have a genetic tendency for stroke or share a lifestyle that contributes to stroke. Short neurological examination and blood test. CT scan(without contrast enhancements) is the most important imaging study at this time for stroke. A CT scan can help rule out a hemorrhagic stroke. MRI, Doppler ultrasound, and arteriography.

TREATMENT
Emergency treatment for stroke depends on whether the patients are having an ischemic stroke blocking an artery or a hemorrhagic stroke involving bleeding into the brain. To treat an ischemic stroke, the doctors must quickly restore blood flow to the brain. Emergency treatment of hemorrhagic stroke focuses on controlling bleeding and reducing pressure in the brain.

COMPLICATIONS
Acute complications occur within 72 hours include cerebral edema, increased Intra Cranial Pressure and possible herniation, hemorrhagic transformation, aspiration pneumonia, and seizures. Postfibrinolytic complications center around bleeding. Of greatest concern is intracerebral hemorrhage, typically occurring within the first 12 hours after treatment.

PROGNOSIS
The prognosis depending upon the premorbid condition, stroke severity, age, and poststroke complications.

THE RELATIONSHIP OF HYPERGLYCEMIA AND STROKE

Diabetes is a prominent risk factor for acute ischemic stroke but not hemorrhagic stroke. Patients with acute ischemic stroke frequently test positive for hyperglycemia, which is associated with a poor clinical outcome

 Hyperglycemic stroke results in increased neuronal damage. The mechanism is believed to be accelerated atherosclerosis, which can affect vessels in many distributions, including small and large vessels. In addition, patients with diabetes may have any of several lipid abnormalities. Elevated levels of triglycerides, low-density lipoproteins (LDL), and very low-density lipoproteins (VLDL), along with lower than normal levels of high-density lipoprotein (HDL), are common findings in the lipid profiles of patients with diabetes. The combined effect of these factors results in promotion of atherosclerosis and thrombosis.

TREATMENT
In terms of primary prevention, treatment of diabetes appears to reduce the incidence of atherosclerotic complications. Intensive approaches to multiple risk factors in stroke have been suggested, including reduction of LDL (to below 100 mg/dL in diabetics), increase of HDL (with fibrates if tolerated, an effect especially beneficial in patients with insulin resistance ), tight glucose control, and hypertensive management. Typically, hyperglycemia in the setting of acute stroke is treated with subcutaneous insulin in a sliding scale

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