Introduction: It is well known that in the first 24 h after stroke onset, plasma glucose concentrations are elevated in 20–43% of patients, of whom more than half are not known to have diabetes mellitus. Glucose levels >8 mmol/l have been found to be predictive of a poor prognosis in ischemic stroke patients. It is thought that the clinical use of insulin infusions has a beneficial effect on hyperglycemia. Indeed, insulin therapy in critically ill patients, including acute stroke patients, is safe and results in lower mortality and complication rates. Unfortunately, the impact of intensive insulin therapy in non-critically ill patients with hyperglycemia is poorly understood. Objectives: It was the aim of this study to determine the clinical efficacy and safety of early-onset therapy with human recombinant insulin: glycemic control measured by reduction in plasma glucose concentrations, vital activity measured by the Barthel index (no significant disability was defined as ≤50, moderate disability was defined as 51–75, and severe disability was defined as ≧75), and neurological deficit measured by the National Institutes of Health Stroke Scale (NIHSS; values ranging from 0 = normal to 42 = worst case) in non-critically ill ischemic stroke diabetic and non-diabetic patients. Design: We used a randomized prospec- tive open trial of insulin-potassium-saline-magnesium (IPSM) infusions in patients after acute ischemic stroke presenting with mild to moderate hyperglycemia. Acute (<24 h) ischemic stroke patients (n = 128) with hyperglycemia on admission between 7.0 and 16 mmol/l with and without type 2 diabetes mellitus (T2DM) were randomly divided into four groups: (1) hyperglycemia associated with T2DM and treated with IPSM (n = 36), (2) hyperglycemia associated with T2DM without IPSM administration (n = 40), (3) hyperglycemia without confirmed T2DM and treated with IPSM (n = 25), and (4) hyperglycemia without confirmed T2DM and without IPSM administration (n = 27). Results: Treatment with the IPSM regimen permitted to normalize blood glucose levels. The neurological deficit according to the NIHSS in stroke patients with hyperglycemia treated with insulin did not worsen in the first 3 days. Results were expressed as means ± SD of NIHSS scores at admission and at day 30. At the same time, the clinical status of patients not treated with insulin worsened. Three weeks after admission, the neurological deficit improved in treated stroke patients (13.5 ± 1.5 and 8.6 ± 1.1, respectively; p < 0.05) and untreated patients with T2DM (13.2 ± 1.7 and 8.9 ± 1.3; p < 0.05). However, the neurological deficit in stroke patients without T2DM, but with hyperglycemia not treated with insulin did not improve significantly (14.4 ± 1.5 and 10.1 ± 1.0, respectively; p > 0.05). Administration of IPSM led to a significant improvement in the neurological status (14.6 ± 1.5 and 8.9 ± 1.3; p < 0.05). Conclusions: Insulin therapy (IPSM infusion) is a safe and effective approach to normalize blood glucose levels after ischemic stroke. Administrati...
Abstract. Background. Transient symptoms do not exclude the possibility of associated brain injury (BI).
Background. Stroke remains the second leading cause of disability and death with the highest reported age-standardized death rates in Eastern Europe compared to Western Europe and the US. Recovery from stroke has been shown to involve reorganization in motor and premotor cortical areas. The resolution of diaschisis has been suggested as a mechanism of early spontaneous recovery. However, there are not enough published prospective studies on the clinical analysis and comparison of different types of cerebral diaschisis, especially in acute stroke patients. We aimed to carry out follow-up analysis of clinical characteristics of cerebrospinal and commissural cerebral diaschisis in acute ischemic stroke patients, to present clinical cases. Materials and methods. We have conducted a prospective, hospital-based, cohort study of acute stroke patients (n = 124) who were admitted to the
Background. Stroke represents a high-risk condition for long-term disability and death. The role of diaschisis in the severity of acute neurological deficit and spontaneous stroke recovery is significant. However, currently there are not enough published prospective, hospital-based, cohort studies that report and analyze clinical characteristics of crossed cerebellar diaschisis in acute stroke patients. Moreover, modern stroke treatment may change clinical representation of diaschisis. The purpose of this study is to determine the features of the clinical manifestations of crossed cerebellar diaschisis after acute cerebral stroke and to improve the efficiency of its diagnosis by comparing the obtained data with the results of the magnetic resonance imaging findings. Materials and methods. We prospectively recruited 124 acute stroke patients, who were admitted to a single department of the academic tertiary care hospital in Kyiv, Ukraine. The primary outcome was the combined incidence of stroke and diaschisis. In the secondary analyses, we studied pathophysiological, anatomical, and clinical features specific to crossed cerebellar diaschisis in a cohort of acute stroke patients with diaschisis. Results. Among 124 selected acute stroke patients admitted to the department, 42 (33.9 %) persons were diagnosed with different forms of diaschisis: cerebrospinal (n = 22), commissural (n = 4), crossed cerebellar (n = 5), crossed cerebellar-hemispheric (n = 6), crossed and ponto-cerebellar diaschisis (n = 5). We have conducted a detailed pathophysiological and clinical analysis of crossed cerebellar diaschisis in acute ischemic stroke patients, described clinical manifestations of crossed cerebellar diaschisis. Utilizing the von Monakow theory of diaschisis, we found a scientific explanation for the pathophysiology of clinical manifestations of that remote form of diaschisis. Conclusions. Results of this study showed that cerebellar infarction is associated not only with typical symptoms of cerebellar lesion, but also with paresis, disturbances of sensitivity, and higher mental functions. Further study of the issues addressed in this article will help to improve the diagnosis and management of patients with acute cerebellar stroke.
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