SERUM CORTISOL AND OUTCOME OF ISCHEMIC BRAIN INFARCTION

The predictive value of serum cortisol level on the prognosis in acute brain infarction of the carotid circulation territory was studied in 101 patients younger than 70 years. The levels of 7 a.m. and 7 p.m. se rum cortisol were measured initially and at 1 week. All patients under went a computed cerebral tomography (CT) within 2 days of the onset of symptoms, and a second CT 3 weeks or 3 month later. Serum cortisol va lues predicted the stroke outcome. Both the 7 a.m. and the 7 p.m. valu es in the initial and 1-week samples correlated positively with the se verity of hemiparesis on the corresponding days. The 7 p.m. values pre dicted better than the 7 a.m. values the functional outcome and case f atality during the 3 month follow-up. Initially and at 1 week, the med ian 7 p.m. serum cortisol values were statistically significantly high er in those with frontally extending infarcts than in those with non-f rontal infarcts. Both 7 a.m. fasting blood glucose and glycosylated he moglobin (HbA1c) measurements were taken within 3 days of the onset in 95 cases. The patients were diagnosed to have prestroke normoglycemia (n = 73) and hyperglycemia (n = 22) on the basis of the HbA1c level. A highly significant (P = 0.0001) correlation was demonstrated between the initial 7 p.m. cortisol and 7 a.m. fasting blood glucose values i n those with prestroke normoglycemia, suggesting that hyperglycemia du ring the acute phase of stroke is a stress response.