INFLUENCE OF HYPERGLYCEMIA ON INFARCT SIZE AND CLINICAL OUTCOME OF ACUTE ISCHEMIC STROKE PATIENTS WITH INTRACRANIAL ARTERIAL-OCCLUSION

We investigated the effects of hyperglycaemia on infarct size of 82 ac ute ischaemic stroke patients with angiographically diagnosed intracra nial occlusion in middle cerebral artery territory. There were 9 diabe tics, 40 non-diabetic hyperglycaemics and 33 non-diabetic normoglycaem ics (mean age 67 +/- 8 SD years, male/female ratio 1:1). For each pati ent the infarct at CT was compared to that predicted from the location of the arterial occlusion. The extent of the infarct was then classif ied as equal to, smaller than and larger than estimated, taking a stan dard anatomical template of arterial territories as reference. The res ults were analysed separately according to the presence or absence of a collateral blood supply (CBS) at angiography. The clinical outcome a t 30 days was also evaluated. The 35 patients lacking CBS had a high f requency of equal to estimated lesions (75%), without substantial diff erences among the three subgroups (72% of hyperglycaemics, 82% of norm oglycaemics and 67% of diabetics; Fisher's exact test not significant for any of the pairwise comparisons). On the contrary, the 47 patients with CBS exhibited an overall predominance of smaller than estimated lesions (66%) but with a very uneven distribution among hyperglycaemic s, normoglycaemics and diabetics (82%, 64% and 0%, respectively; p < 0 .05 at Fisher's exact test for diabetics vs hyperglycaemics). Finally, the clinical outcome was bad (death and neurological impairment) in 8 9% of diabetics, 72% of hyperglycaemics and 54% of normoglycaemics (p < 0.05). These results suggest that in patients with intracranial arte rial occlusion associated with CBS the effects of hyperglycaemia might be beneficial in non-diabetics and harmful in diabetics. On the other hand, in absence of CBS high serum glucose levels does not seem to in fluence the size of cerebral infarcts.