STROKE IN THE DIABETIC PATIENT

A higher prevalence of stroke is found in the patient with both diagno sed and undiagnosed diabetes and glucose intolerance. Because of local cerebral acidosis caused by ischemia and hyperglycemia, morbidity and mortality from a stroke are increased. Most studies show that individ uals with admission serum glucose >120 mg/dl (6.7 mM) have a higher mo rbidity and mortality from a stroke. The prevalence of cerebral infarc ts, especially lacunar infarcts, is increased and the prevalence of su barachnoid hemorrhage, cerebral hemorrhage, and transient ischemic att acks are decreased in the diabetic patient. Age, race, hypertension, a nd the presence of diabetic nephropathy and coronary and peripheral va scular disease are risk factors for stroke in the diabetic patient, wh ereas obesity, smoking, hyperlipidemia, and glycemic control are not. Investigation and treatment of the diabetic patient with a stroke is d iscussed.