How important is hyperglycemia during acute brain infarction?

The Neurologist
Askiel BrunoThomas A Kent

Abstract

Although well supported by animal studies, it remains unproven whether lowering hyperglycemia during acute cerebral infarction will improve outcomes. Further support for this therapeutic approach comes from clinical studies in acute myocardial infarction and in ventilated postsurgical patients, where lowering hyperglycemia improved outcomes. Animal studies support the hypothesis that hyperglycemia during acute brain ischemia augments the brain injury, but only in models with reperfusion. The available human studies to date are all observational and they usually find an association between hyperglycemia during acute cerebral infarction and worse outcome. Also, there is evidence that hyperglycemia during acute cerebral infarction is detrimental only with reperfusion. This association appears to be linear in the glucose ranges tested (normal to high). In addition, there is an association between admission hyperglycemia and hemorrhagic conversion of an acute cerebral infarct when thrombolytics are used. Sufficient evidence has accumulated to proceed to clinical efficacy trials to see if tight glycemic control compared with persistent hyperglycemia during acute cerebral infarction will improve outcomes. If such therapy proves benefi...Continue Reading

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Citations

Nov 3, 2005·Current Neurology and Neuroscience Reports·David PalestrantStephan A Mayer
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