Background Identification of factors that predispose to bleeding into
ischemic brain could lead to safer use of thrombolytic agents in the s
etting of ischemic stroke. Recently de Courten-Meyers and colleagues r
eported that occluding the middle cerebral artery of markedly hypergly
cemic cats was associated with 5-fold more frequent and 25-fold more e
xtensive hemorrhage into infarcts than in normoglycemic animals. Hemor
rhage associated with hyperglycemia in cats was much more pronounced w
ith reperfusion than with permanent middle cerebral artery occlusion.
Case Descriptions We describe two patients with a unique presentation
of diffuse hemorrhagic infarction of the caudate and lentiform nuclei
associated with initially marked hyperglycemia and the subsequent deve
lopment of hemichorea. Conclusions We hypothesize that the marked hype
rglycemia due to poor control of diabetes contributed to the hemorrhag
ic change of the caudate and lenticular nuclei. Because the hemorrhage
in hyperglycemic cats was more pronounced in the setting of reperfusi
on, hemorrhagic risk associated with hyperglycemia should be investiga
ted, particularly in ongoing thrombolytic treatment trials for acute i
schemic stroke. We encourage other acute stroke investigators to prosp
ectively look at the risk of brain hemorrhage in stroke patients with
marked hyperglycemia.