Blood brain barrier destruction in hyperglycemic chorea in a patient with poorly controlled diabetes

Iwata, Atsushi; Koike, Fumiko; Arasaki, Keisuke; Tamaki, Mikio

doi:10.1016/s0022-510x(98)00325-6

Cited by 63 publications

(50 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent case report described a diabetic patient in whom a small area of enhancement was observed in the thalamus on contrast MRI 24 hours before the development of a lacunar infarct (where the enhancement had been observed). 65 This suggests that breakdown of the blood-brain barrier was the initiating event leading to the lacunar infarct. However, scanning patients shortly before they develop their stroke is so fortuitous (even more so than finding a blocked perforating artery postmortem) that such observations are likely to remain extremely unusual.…”

Section: Might the Leak Simply Be The Results Of Progressive Brain Dammentioning

confidence: 99%

Is Breakdown of the Blood-Brain Barrier Responsible for Lacunar Stroke, Leukoaraiosis, and Dementia?

Wardlaw

Sandercock²,

Dennis³

et al. 2003

Stroke

557

443

View full text Add to dashboard Cite

show abstract

Section: Might the Leak Simply Be The Results Of Progressive Brain Dammentioning

confidence: 99%

Is Breakdown of the Blood-Brain Barrier Responsible for Lacunar Stroke, Leukoaraiosis, and Dementia?

Wardlaw

Sandercock²,

Dennis³

et al. 2003

Stroke

557

443

View full text Add to dashboard Cite

show abstract

“…Our case was hyperglycaemic and had an elevated serum osmolality; hyperglycaemia can cause disruption of cerebral autoregulation, endothelial cells and the blood -brain barrier, resulting in plasma leakage and vasogenic oedema. 8,9 Oedema may lead to compression of fibre tracts, which in turn causes demyelination; 10 and endothelial injury leads to the release of myelinotoxic factors from the damaged cells leading to demyelination. The mechanism of how this leads to selective myelinolysis in CPM is unknown.…”

Section: Discussionmentioning

confidence: 99%

Central pontine myelinolysis in a patient with epilepsia partialis continua and hyperglycaemic hyperosmolar state

2010

View full text Add to dashboard Cite

Central pontine myelinolysis (CPM) is a demyelinating disorder, which is associated most commonly with the rapid correction of hyponatraemia and other abrupt changes in physiological osmotic conditions. This includes the treatment of hyperosmolar hyperglycaemia in diabetes mellitus (DM) sufferers. Herein, we report a case of CPM in a 55-y-old patient with new-onset DM who presented with partial focal seizures and a sudden-onset right-sided hemiplegia. Magnetic resonance imaging revealed a lesion in the central pons. The patient responded to glucose control and antiepileptic medication, and achieved a recovery of limb function within 17 d of admission. CPM occurred in this patient before the correction of hyperglycaemic hyperosmolar state, and a disturbance in his initial electrolytes was not found. This report is the first documented case of long-term hyperglycaemic hyperosmolar state leading to CPM, and highlights that CPM can present as an isolated hemiplegia.

show abstract

“…Preclinical studies have demonstrated that DM is associated with increased BBB permeability [14,15] . The potential relationship between diabetes and BBB disruption has also been reported in a case report [16] . Changes in BBB function in patients with DM may be strongly related to other functional abnormalities of the microvascular and cellular responses to ischemia [17] .…”

mentioning

confidence: 78%

Blood Brain Barrier Disruption in Diabetic Stroke Related to Unfavorable Outcome

Jackson

et al. 2016

Cerebrovasc Dis

View full text Add to dashboard Cite

Background: Diabetes mellitus (DM) is associated with a wide range of microvascular abnormalities in the brain. These include the dysfunction of the blood brain barrier (BBB). In this study, we test the hypotheses that disruption of the BBB in patients presenting with acute stroke is common in patients with DM and is related to outcome. Methods: Sixty-two consecutive patients with ischemic stroke in the middle cerebral artery territory were enrolled within 3-7 days after onset. In ischemic lesion, BBB disruption was detected by parenchymal enhancement (PE) on 5 min delayed post-contrast T1 weighted imaging. National Institute of Health Stroke Score (NIHSS) assessed neurologic impairment on admission. Clinical outcome at 3 months was classified as unfavorable if the modified Rankin scale was >1. The independent factors associated with clinical outcome were analyzed using multivariate logistic regression analysis and OR with its 95% CIs were estimated. Results: An unfavorable stroke outcome was found in 19 diabetic patients and 21 non-diabetic patients. Diabetic patients had a significantly higher frequency of PE than non-diabetic patients (58.6 vs. 27.3%, p = 0.013) and DM was independently associated with PE (OR 4.40; 95% CI 1.22-15.83; p = 0.023). PE was significantly more common in diabetic patients with unfavorable stroke outcome (73.7%) than in other 3 subgroups: diabetic patients with favorable stroke outcome (30.0%), non-diabetic patients with favorable stroke outcome (38.1%) and unfavorable stroke outcome (8.3%; p = 0.002). PE was independently associated with unfavorable outcome (UO) in diabetic stroke (DS; OR 7.04; 95% CI 1.20-41.52; p = 0.031). Admission NIHSS score was associated with UO in non-DS (NDS) (OR 1.71; 95% CI 1.10-2.66; p = 0.017). Conclusions: Compared with NDS, DS had increased BBB disruption defined by the presence of PE. A different form of the relationship between admission NIHSS and UO in NDS, BBB disruption was related with UO in diabetic patients after stroke.

show abstract

Blood brain barrier destruction in hyperglycemic chorea in a patient with poorly controlled diabetes

Cited by 63 publications

References 16 publications

Is Breakdown of the Blood-Brain Barrier Responsible for Lacunar Stroke, Leukoaraiosis, and Dementia?

Is Breakdown of the Blood-Brain Barrier Responsible for Lacunar Stroke, Leukoaraiosis, and Dementia?

Central pontine myelinolysis in a patient with epilepsia partialis continua and hyperglycaemic hyperosmolar state

Blood Brain Barrier Disruption in Diabetic Stroke Related to Unfavorable Outcome

Contact Info

Product

Resources

About