HYPERGLYCEMIA AND HEMORRHAGIC TRANSFORMATION OF CEREBRAL INFARCTS

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.