CLINICAL PROFILE AND STROKE TOPOGRAPHY AMONG DIABETICS WITH ACUTE ISCHEMIC STROKE

Susan Dsouza, Anto Ignat Stany M, Peter George

Abstract


Introduction: Stroke is the most devastating vascular complication in diabetes for its associated morbidity and mortality. Dyslipidaemia,
hypertension, obesity and atherosclerosis are higher among diabetics, which make them more vulnerable to ischemic stroke. This study was done to
corelate clinical prole and topography of strokes occurring in diabetics.
Materials and methods: This retrospective chart based descriptive study was done among diabetics with acute stroke at a tertiary care centre in
Southern India over 2 years from 1st January 2016. The patients’ data on demography, history, and investigations including neuroimaging were
obtained from medical records and entered to a pre-formatted data sheet for further analysis. The outcome of the study was complete, partial,
functional recovery or death.
Results: Among the 112 diabetic strokes selected, 8.9% had diabetes for less than a year. In this study, middle cerebral artery (MCA) territory
strokes were common (62.5%) followed by lacunar infarcts (21.42%) and posterior cerebral artery (PCA) territory infarcts (9.2%). Sixty-six
percent of lacunar infarcts (16 of 24 patients) were also in the MCA territory. Patients with MCA territory infarcts had higher HbA1C levels. MCA
territory infarcts were associated with poorer outcomes, signicantly longer duration of hospital stay and slower recovery. Mortality was higher in
patients with higher HbA1C levels. Mean duration of hospital stay was 9.16 ±5.21 days.
Conclusion: Diabetics with strokes showed higher incidences of MCA territory infarction and lacunar strokes.. Poor glycaemic control was
associated with poorer outcomes and slower recovery with higher mortality.


Keywords


Stroke, Diabetes, Clinical Prole, Topography, Lacunar Infarcts, Ct, Mr Imaging.

Full Text:

PDF

References


Unnikrishnan R, Anjana RM, Mohan V. Diabetes mellitus and its complications in India. Nat Rev Endocrinol 2016; 12(6):357-70.

Fujishima M, Kiyohara Y, Kato I, Ohmura T, Iwamoto H, Nakayama K, et al. Diabetes and cardiovascular disease in a prospective population survey in Japan: The Hisayama Study. Diabetes 1996; 45(Supplement 3):S14-6.

Li SC, Schoenberg BS, Wang CC, Cheng XM, Bolis CL, Wang KJ. Cerebrovascular disease in the People's Republic of China: epidemiologic and clinical features. Neurology 1985; 35(12):1708-13.

Aronson SM. Intracranial vascular lesions in patients with diabetes mellitus. J NeuropatholExpNeurol 1973; 32(2):183-96.

Razdan S, Kaul RL, Motta A, Kaul S. Cerebrovascular disease in rural Kashmir, India. Stroke 1989; 20:1691-3.

Bharucha NE, Bharucha EP, Bharucha AE, Bhise AV, Schoenberg BS. Prevalence of stroke in the Parsi community of Bombay. Stroke 1988; 19: 60-2.

Banerjee TK, Mukherjee CS, Sarkhel A. Stroke in the urban population of Calcutta- an epidemiological study.Neuroepidemiology 2001; 20: 201-7.

Abraham J, Rao PSS, Inbaraj SG, Shetty G, Jose CJ. An epidemiological study of hemiplegia due to stroke in South India.Stroke 1970; 1: 477-81.

Gourie-Devi M, Gururaj G, Satishchandra P, Subbakrishna DK. Prevalence of neurological disorders in Bangalore, India: a community-based study with comparison between urban and rural areas. Neuroepidemiology 2004; 23: 261-8.

Megherbi SE, Milan C, Minier D, Couvreur G, Osseby GV, Tilling K, et al. European BIOMED Study of Stroke Care Group. Association between diabetes and stroke subtype on survival and functional outcome 3 months after stroke: data from the European BIOMED Stroke Project. Stroke 2003; 34(3):688-94.

Zhang XD, Chen YR, Ge L, Ge ZM, Zhang YH. Features of stroke in Chinese diabetes patients: a hospital-based study. J Int Med Res 2007; 35(4):540-6.

Jorgensen H, Nakayama H, Raaschou HO, Olsen TS. Stroke in patients with diabetes.The Copenhagen Stroke Study. Stroke 1994; 25(10):1977-84.

Arboix A, Rivas A, García-Eroles L, de Marcos L, Massons J, Oliveres M. Cerebral infarction in diabetes: clinical pattern, stroke subtypes, and predictors of in-hospital mortality. BMC Neurology 2005; 5(1):9.

Ichikawa H, Kuriki A, Kinno R, Katoh H, Mukai M, Kawamura M. Occurrence and clinicotopographical correlates of brainstem infarction in patients with diabetes mellitus. J Stroke Cerebrovasc Dis 2012; 21(8):890-7.

Palacio S, McClure LA, Benavente OR, Bazan III C, Pergola P, Hart RG. Lacunar strokes in patients with diabetes mellitus: risk factors, infarct location, and prognosis: the secondary prevention of small subcortical strokes study. Stroke 2014; 45(9):2689-94.

Huisa BN, Roy G, Kawano J, Schrader R. Glycosylated hemoglobin for diagnosis of pre-diabetes in acute ischemic stroke patients. J Stroke Cerebrovasc Dis 2013; 22:e564–7.

Tziomalos K, Spanou M, Bouziana SD, Papadopoulou M, Giampatzis V, Kostaki S, et al. Type 2 diabetes is associated with a worse functional outcome of ischemic stroke. World J Diabetes 2014; 5:939–44.

Kiers L, Davis SM, Larkins R, Hopper J, Tress B, Rossiter SC et al. Stroke topography and outcome in relation to hyperglycaemia and diabetes. J NeurolNeurosurg Psychiatry 1992: 55:263-70.

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.

Iwase M, Yamamoto M, Yoshinari M, Ibayashi S, Fujishima M. Stroke topography in diabetic and nondiabetic patients by magnetic resonance imaging. Diabetes Res ClinPract 1998; 42(2):109-16.

Li H, Kang Z, Qiu W, Hu B, Wu AM, Dai Y, et al. Hemoglobin A1C is independently associated with severity and prognosis of brainstem infarctions. J NeurolSci 2012; 317(1-2):87-91.

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.

Nannetti L, Paci M, Baccini M, Rinaldi LA, Taiti PG. Recovery from stroke in patients with diabetes mellitus. J Diabetes Complications 2009; 23(4):249-54.

Hjalmarsson C, Manhem K, Bokemark L, Andersson B. The role of prestrokeglycemic control on severity and outcome of acute ischemic stroke. Stroke Res Treat 2014; 2014:e694569.


Refbacks

  • There are currently no refbacks.