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July2005 Vol.42 Issue:        2        Table of Contents
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Relationship between Hyperglycemia on Admission and Severity of Acute First-Ever Anterior Cerebral Circulation Infarction

Bukhary FES1, Soliman WT2, Mohsen AMS3, Al-Sharkawy EA4
Departments of Internal Medicine1, Neurology2, Radiodiagnosis3,Clinical Pathology4, El-Minia University

ABSTRACT

Objective: Ischemic stroke is a leading cause of death and long-term disability; and hyperglycemia is believed to aggravate cerebral ischemia. Aim of the work: To evaluate relationship between admission hyperglycemia and clinical severity; stroke features in brain CT, short-term functional outcome in patients with first-ever acute total anterior cerebral infarction. Subjects and methods: Fifty-five consecutive patients with first -ever acute (< 24 hours) anterior cerebral infarction were included in the study within 72 hours after onset of symptoms. Baseline clinical variables and risk factors were analyzed. National Institute of Health Stroke Scale (NIHSS) was used to asses the clinical severity of neurological deficit on admission and on day 7 after admission. All patients had brain CT without contrast enhancement on day 3 and day 7 after stroke onset. Size of infarction, presence or absence of brain edema, hemorrhagic transformation and degree of X- ray attenuation in centre of infarction were determined. Patients were classified into 2 groups according to their random blood sugar at time of admission; Group I: 17 patients with random blood glucose level<140 mg/dl; and group II: 38 patients with hyperglycemia (level ≥ 140 mg/dl). Both groups were compared in terms of NIHSS score, laboratory data, admission blood pressure, and brain CT findings. The primary outcome was assessed after 30 days of admission by modified Rankin scale (mRsc). Patients with good outcome (grades ≤3; 41 patients) and patients with poor outcome (grades >3 or in-hospital death; 14 patients) were compared as group A and group B respectively. Logistic regression was used to examine the relationship between admission blood glucose level and NIHSS score, CT features and mRsc variables. Results: Group II showed significantly high NIHSS score at 1st day of admission, big infarction size (>6 cm3) at 7th day of admission and high mRSc after one month. Those with past history of diabetes mellitus in group II showed insignificant difference with those non diabetic in the same group. The neurological outcome (mRsc) is strongly influenced by baseline NIHSS score, admission hyperglycemia and higher initial blood pressure. Those with good outcome (group A) were younger and had smaller infarcts volume in brain CT than those with bad outcome (group B). Conclusion: Admission hyperglycemia is an independent determinant of expansion; clinical severity of acute total anterior cerebral infarction and associated with worse functional outcome. NIHSS score in 1st day and infarction size at 7th days of stroke onset had a predominant influence upon in-hospital death and short term outcome. Increased attenuation or hemorrhagic transformation had no predictive value for short term prognosis.

(Egypt J. Neurol. Psychiat. Neurosurg., 2005, 42(2): 453-463).

 





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