Hyperglycemia is a stress response in acute stroke.

Abstract

To explore further the relation between admission glucose concentration and outcome in stroke, we measured glucose, fructosamine, and glycosylated hemoglobin concentrations on admission in 216 patients seen within 24 hours after the onset of their first stroke. Fructosamine concentration reflects the degree of glycemia in the preceding 4-6 weeks and glycosylated hemoglobin concentration reflects that in the preceding 3 months. Based on clinical, computed tomographic, and necropsy findings, strokes were classified as cortical infarction, lacunar infarction, or intracerebral hemorrhage. Analyses were done including and excluding 47 diabetic patients. No correlation between neurologic outcome as mortality and fructosamine or glycosylated hemoglobin concentration was found. Survival showed a significant correlation with admission glucose concentration only for patients with intracerebral hemorrhage. Our results suggest that hyperglycemia is unlikely to worsen the outcome of acute stroke and that hyperglycemia probably represents either a latent diabetic state or a stress response. (Stroke

Iron-related damage in acute ischemic stroke.

“…18 However, although both serum ferritin and glycemia are elevated during stress, the weak correlation with serum cortisol and the fact that ferritin was selected as the predictive independent variable in the logistic regression analysis suggest that high ferritin levels may have a direct neurotoxic effect in ischemic acute stroke.…”

Management of Hyperglycemia in Acute Stroke

“…6 In any given stroke population the prevalence of diabetes is approximately 8% to 20%, with a further 6% to 42% having evidence of previously unrecognized diabetes before the acute event. 2,[7][8][9][10][11] Such estimates are, however, complicated by the high prevalence of poststroke hyperglycemia; in one series of acute stroke patients it was estimated that up to 68% had poststroke hyperglycemia, defined by a plasma glucose concentration Ͼ6.0 mmol/L. 2 It is possible that poststroke hyperglycemia is primarily a stress response in relation to stroke size and severity 12 : however, poststroke hyperglycemia is prevalent across all clinical subtypes and severities of stroke and is not restricted to those most severely affected.…”

Predictors of Hyperacute Clinical Worsening in Ischemic Stroke Patients Receiving Thrombolytic Therapy

“…16,17 However, initial human studies reported no association between hyperglycemia and stroke outcome, suggesting that the former represented a stress response to the latter. 18 Several reports since then have shown that hyperglycemia, especially immediately after symptom onset, is indeed related to worse outcome in patients with AIS. 9,10,19 -21 This association is evident in patients with nonlacunar strokes but not in those with lacunar ones.…”