The association of hyperglycemia with cerebral edema in stroke.

Abstract

SUMMARY A retrospective review of stroke patients admitted to our hospital revealed 39 patients diagnosed as suffering an acute completed ischemic stroke who also had had fasting (AC) serum glucose determinations and sequential computer tomography (CT) studies. The patients were divided into three groups on the basis of mean AC serum glucose: Group 1 (n = 12) mean serum AC glucose > 150 mg/dl; Group 2 (n = 13) mean serum AC glucose 100-150 mg/dl; and Group 3 (n = 14) mean serum AC glucose < 100 mg/dl.CT scans performed on each patient were studied for the presence of mid line shift and/or ventricular compression, which were interpreted as evidence of cerebral edema. The three groups were comparable with respect to mean age, average mean arterial blood pressure and initial infarct size.Our results show that in Group 1,42% of the patients died within the first week following their CVA with dinkal evidence of transtentorial herniation confirmed by CT or autopsy. In contrast, none of the Group 3 patients died and only one showed radiological evidence for cerebral edema. Group 2 patients showed intermediate mortality and evidence of cerebral edema. These trends were statistically significant at p < 0.005. In addition, the combined hyperglycemic group (1 and 2) had a significantly higher rate of development of hypodensity on CT (p < 0.05) than the normoglycemic group.Our findings suggest that patients with hyperglycemia in association with then-CVA develop more pronounced cerebral edema and have a worse clinical outcome. Possible pathophysiological mechanisms that may underlie this observation are discussed.

Republished: Society for Neuroscience in Anesthesiology and Critical Care Expert Consensus Statement: Anesthetic Management of Endovascular Treatment for Acute Ischemic Stroke*

“…[74][75][76][77][78][79][80][81][82] However, HG may not be associated with poor outcome in patients with lacunar stroke. [82][83][84] The association between HG and poor clinical outcome is more pronounced in patients treated with thrombolytic therapy than in patients not treated with tPA.…”

Predictors for Cerebral Edema in Acute Ischemic Stroke Treated With Intravenous Thrombolysis

“…Baseline blood glucose was an independent predictor for CED development in our study, including severe edema, as was indicated but not statistically significantly associated in some earlier studies. 12,28,29 One explanation for this may be an impaired blood-brain barrier caused by high levels of glucose. 30 Level of consciousness has been found to be an independent predictor of all types of CED.…”

Regulation of Glucose Transporter 3 Surface Expression by the AMP-Activated Protein Kinase Mediates Tolerance to Glutamate Excitation in Neurons

“…This implies that some neurons require an increased capacity for glucose uptake over an extended period of time (1-4 h) to survive the energy crisis created during glutamate excitation. Interestingly, hyperglycemic conditions during reperfusion after both transient and focal ischemia have been shown to significantly increase infarct size and neuronal injury in vivo (Berger and Hakim, 1986;Nedergaard, 1987). Therefore, it may be the case that many neurons within the penumbra region of an infarct have an increased capacity for glucose uptake for a number of hours after an ischemic event (Vannucci et al, 1996(Vannucci et al, , 1998.…”