This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (68)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal

Nadya Kagansky, MD; Shmuel Levy, MD; Hilla Knobler, MD

Arch Neurol. 2001;58:1209-1212.

Background  Ischemic stroke is a leading cause of death and long-term disability, and hyperglycemia is believed to aggravate cerebral ischemia.

Objectives  To review animal and human studies on the relationship between hyperglycemia and brain ischemia that elucidate some of the mechanisms for the deleterious effect of hyperglycemia. To discuss present and future clinical recommendations for glucose control.

Methods  Computerized data sources and published indexes and articles from 1976 through 2000 were searched for human studies that evaluated the association between stroke and hyperglycemia, and studies focused on experimental models of hyperglycemic animals with focal and global brain ischemia.

Results  Most human studies have shown that in acute stroke, admission hyperglycemia in patients with or without diabetes is associated with a worse clinical outcome than in patients without hyperglycemia. This association is more consistent in the nonlacunar type of stroke. Animal studies support these findings by showing both in global and in focal postischemic models that hyperglycemia exaggerates the following damaging processes: intracellular acidosis, accumulation of extracellular glutamate, brain edema formation, blood-brain barrier disruption, and tendency for hemorrhagic transformation. Insulin treatment of hyperglycemic animals was found to have a beneficial effect in focal and global brain ischemia, which may be mediated by the glucose-reduction effect or by a direct neuroprotection.

Conclusions  Most studies show the deleterious effect of early hyperglycemia, especially in patients with nonlacunar focal or global ischemia. Clinical trials of intensive insulin treatment are needed. Meanwhile simple measures to avoid excessive hyperglycemia are recommended.

From the Department of Geriatrics (Drs Kagansky and Levy) and the Metabolic Service (Dr Knobler), Kaplan Medical Center, Rehovot, and the Hebrew University Hadassah Medical School of Medicine, Jerusalem, Israel.

RELATED ARTICLE

Archives of Neurology Reader's Choice: Continuing Medical Education
Arch Neurol. 2001;58(8):1319-1321.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Review: PPARs as new therapeutic targets for the treatment of cerebral ischemia/reperfusion injury
Collino et al.
Therapeutic Advances in Cardiovascular Disease 2008;2:179-197.
ABSTRACT  

Early Detection of an Acute Cerebral Event During Cardiopulmonary Bypass Using a Bispectral Index Monitor
Leggat and Fischer
SEMIN CARDIOTHORAC VASC ANESTH 2008;12:80-82.
ABSTRACT  

Endogenous Arginine-Phenylalanine-Amide-related Peptides Alter Steady-state Desensitization of ASIC1a
Sherwood and Askwith
J. Biol. Chem. 2008;283:1818-1830.
ABSTRACT | FULL TEXT  

Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.
Adams et al.
Circulation 2007;115:e478-e534.
ABSTRACT | FULL TEXT  

Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists
Adams et al.
Stroke 2007;38:1655-1711.
ABSTRACT | FULL TEXT  

Prior TIA, lipid-lowering drug use, and physical activity decrease ischemic stroke severity
Deplanque et al.
Neurology 2006;67:1403-1410.
ABSTRACT | FULL TEXT  

Idiopathic acute transverse myelitis: a clinical study and prognostic markers in 45 cases
Bruna et al.
Mult Scler 2006;12:169-173.
ABSTRACT  

Long-term Glycemic Control and Postoperative Infectious Complications
Dronge et al.
Arch Surg 2006;141:375-380.
ABSTRACT | FULL TEXT  

Acanthocytosis as a predisposing factor for non-ketotic hyperglycaemia induced chorea-ballism
Pisani et al.
J. Neurol. Neurosurg. Psychiatry 2005;76:1717-1719.
ABSTRACT | FULL TEXT  

Prevalence of Abnormal Glucose Tolerance Following a Transient Ischemic Attack or Ischemic Stroke
Kernan et al.
Arch Intern Med 2005;165:227-233.
ABSTRACT | FULL TEXT  

Acute Hyperglycemia Alters Mood State and Impairs Cognitive Performance in People With Type 2 Diabetes
Sommerfield et al.
Diabetes Care 2004;27:2335-2340.
ABSTRACT | FULL TEXT  

Predictors of Hyperacute Clinical Worsening in Ischemic Stroke Patients Receiving Thrombolytic Therapy
Leigh et al.
Stroke 2004;35:1903-1907.
ABSTRACT | FULL TEXT  

Intensive Insulin Therapy for Critically Ill Patients
Lewis et al.
The Annals of Pharmacotherapy 2004;38:1243-1251.
ABSTRACT | FULL TEXT  

Role of AT1 receptors and NAD(P)H oxidase in diabetes-aggravated ischemic brain injury
Kusaka et al.
Am. J. Physiol. Heart Circ. Physiol. 2004;286:H2442-H2451.
ABSTRACT | FULL TEXT  

Hypoglycaemia exacerbates ischaemic retinal injury in rats
Casson et al.
Br. J. Ophthalmol. 2004;88:816-820.
ABSTRACT | FULL TEXT  

The Effect of Hyperglycemia on Experimental Retinal Ischemia
Casson et al.
Arch Ophthalmol 2004;122:361-366.
ABSTRACT | FULL TEXT  

Glucose but Not Lactate in Combination With Acidosis Aggravates Ischemic Neuronal Death In Vitro
Cronberg et al.
Stroke 2004;35:753-757.
ABSTRACT | FULL TEXT  

Toward Wisdom From Failure: Lessons From Neuroprotective Stroke Trials and New Therapeutic Directions
Gladstone et al.
Stroke 2002;33:2123-2136.
ABSTRACT | FULL TEXT  

Diffusion-Weighted and Gradient Echo Magnetic Resonance Findings of Hemichorea-Hemiballismus Associated With Diabetic Hyperglycemia: A Hyperviscosity Syndrome?
Chu et al.
Arch Neurol 2002;59:448-452.
ABSTRACT | FULL TEXT