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The Association between Neurological Prognosis and Serum Glucose Level by Stroke Subtype in Acute Ischemic Stroke
Korean J Clin Geri 2017 Dec;18(2):82-86
Published online December 29, 2017;  https://doi.org/10.15656/kjcg.2017.18.2.82
Copyright © 2017 The Korean Academy of Clinical Geriatrics.

Tae-Won Kim, Jeong-Min So, Sung-Woo Chung, In-Uk Song

Department of Neurology, College of Medicine, The Catholic University of Korea, Incheon, Korea
Received June 5, 2017; Accepted August 29, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Background: Studies evaluating the prognostic value of admission glucose level (AGL) by stroke subtypes are rare. We aimed to evaluate the association between AGL and short-term outcome by each stroke subtype.
Methods: We recruited 265 patients with acute infarction who were consecutively admitted to our hospital after acute stroke. We classified the patients into lacunar, large artery artherosclerosis (LAA) or cardioembolic infarction according to the TOAST stroke classification. AGL were measured at admission. The National Institutes of Health Stroke Scale (NIHSS) were evaluated initially and at 5 admission days.
Results: Fifty patients were lacunar group, 190 were LAA group and 25 were cardioembolic group. All enrolled patients with higher AGL had significantly worse functional outcomes in acute stage compared to the low AGL group (P=0.005). In respect to stroke suptype, AGL was significantly associated with worse functional outcome in acute stage only in LAA group (P=0.002). There were no association between AGL and functional outcome in lacunar or cardioembolic infarction.
Conclusion: The prognostic implication of AGL in acute ischemic stroke was different depending on each stroke subtype. Although AGL predicted worse functional outcome only in LAA group, it did not associate with functional outcome in the lacunar or cardioembolic infarction.
Keywords : Admission glucose level, Acute stroke, Functional outcome
References
  1. Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 2001;32:2426-32.
    Pubmed CrossRef
  2. Mazighi M, Labreuche J, Amarenco P. Glucose level and brain infarction: a prospective case-control study and prospective study. Int J Stroke 2009;4:346-51.
    Pubmed CrossRef
  3. Parsons MW, Barber PA, Desmond PM, Baird TA, Darby DG, Byrnes G, et al. Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. Ann Neurol 2002;52:20-8.
    Pubmed CrossRef
  4. Gray CS, Hildreth AJ, Sandercock PA, O'Connell JE, Johnston DE, Cartlidge NE, et al. Glucose-potassium-insulin infusions in the management of post-stroke hyperglycaemia:the UK Glucose Insulin in Stroke Trial (GIST-UK). Lancet Neurol 2007;6:397-406.
    CrossRef
  5. de Courten-Myers G, Myers RE, Schoolfield L. Hyperglycemia enlarges infarct size in cerebrovascular occlusion in cats. Stroke 1988;19:623-30.
    Pubmed CrossRef
  6. McBride DW, Matei N, Camara JR, Louis JS, Oudin G, Walker C, et al. Acute hyperglycemia does not affect brain swelling or infarction volume after middle cerebral artery occlusion in rats. Acta Neurochir Suppl 2016;121:251-5.
    Pubmed CrossRef
  7. Prado R, Ginsberg MD, Dietrich WD, Watson BD, Busto R. Hyperglycemia increases infarct size in collaterally perfused but not end-arterial vascular territories. J Cereb Blood Flow Metab 1988;8:186-92.
    Pubmed CrossRef
  8. Scott JF, Robinson GM, French JM, O'Connell JE, Alberti KG, Gray CS. Prevalence of admission hyperglycaemia across clinical subtypes of acute stroke. Lancet 1999;353:376-7.
    CrossRef
  9. Shimoyama T, Shibazaki K, Kimura K, Uemura J, Shiromoto T, Watanabe M, et al. Admission hyperglycemia causes infarct volume expansion in patients with ICA or MCA occlusion:association of collateral grade on conventional angiography. Eur J Neurol 2013;20:109-16.
    Pubmed CrossRef
  10. Weir CJ, Murray GD, Dyker AG, Lees KR. Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow up study. Bmj 1997;314:1303-6.
    Pubmed KoreaMed CrossRef
  11. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35-41.
    Pubmed CrossRef
  12. Kang DW, Chalela JA, Ezzeddine MA, Warach S. Association of ischemic lesion patterns on early diffusionweighted imaging with TOAST stroke subtypes. Arch Neurol 2003;60:1730-4.
    Pubmed CrossRef
  13. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604-7.
    Pubmed CrossRef
  14. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20:864-70.
    Pubmed CrossRef
  15. Jorgensen H, Nakayama H, Raaschou HO, Olsen TS. Stroke in patients with diabetes. The Copenhagen Stroke Study. Stroke 1994;25:1977-84.
    Pubmed CrossRef
  16. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991;337:1521-6.
    CrossRef
  17. Miedema I, Luijckx GJ, Brouns R, De Keyser J, Uyttenboogaart M. Admission hyperglycemia and outcome after intravenous thrombolysis: is there a difference among the strokesubtypes? BMC Neurol 2016;16:104.
    Pubmed KoreaMed CrossRef
  18. Uyttenboogaart M, Koch MW, Stewart RE, Vroomen PC, Luijckx GJ, De Keyser J. Moderate hyperglycaemia is associated with favourable outcome in acute lacunar stroke. Brain 2007;130(Pt 6):1626-30.
    Pubmed CrossRef
  19. Kim BJ, Kim JS. Ischemic stroke subtype classification: an asian viewpoint. J Stroke 2014;16:8-17.
    Pubmed KoreaMed CrossRef
  20. Kolominsky-Rabas PL, Weber M, Gefeller O, Neundoerfer B, Heuschmann PU. Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and longterm survival in ischemic stroke subtypes: a population-based study. Stroke 2001;32:2735-40.
    Pubmed CrossRef
  21. Stewart JA, Dundas R, Howard RS, Rudd AG, Wolfe CD. Ethnic differences in incidence of stroke: prospective study with stroke register. BMJ 1999;318:967-71.
    Pubmed KoreaMed CrossRef
 

December 2017, 18 (2)
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