DIABETES AND BRAIN ISCHEMIA

Diabetes influences brain ischemia in a number of different ways. Diab etes causes and exacerbates macroangiopathies, increases the severity of ischemia, and increases stroke mortality, Unfortunately, few studie s have examined in sufficient depth the influence of diabetes on the v arious vascular lesions that cause brain ischemia, These can be divide d into: 1) cardiac-origin brain embolism; 2) atherosclerosis of the ao rta and the large extracranial arteries-the internal carotid arteries (ICAs) and the vertebral arteries (VAs); 3) atherosclerosis of the lar ge intracranial arteries-ICAs, anterior, middle, and posterior cerebra l arteries, the VAs, and the basilar artery; 4) intracranial atheromat ous branch disease of macroscopically visible branches of the intracra nial arteries enumerated in 3; and 5) degenerative abnormalities such as lipohyalinosis and fibrinoid changes within penetrating artery bran ches visible only microscopically. The last three types of disorders a ll can cause deep subcortical brain infarcts, the predominant type of brain infarction found in Japan.