The Relationship of Hyperglycemia and Stroke

7/31/2019 The Relationship of Hyperglycemia and Stroke

1/19

THE RELATIONSHIP OF

HYPERGLYCEMIA AND STROKE

INA JULIA SARI

030.07.114


2/19

HYPERGLYCEMIA

Hyperglycemia is the high blood sugar (glucose)level.

High blood glucose happens when the body hastoo little insulin or when the body can not useinsulin properly.


3/19

PATHOGENESIS


4/19

THE SYMPTOMS

Polydipsia (frequently thirsty)

Polyuria (frequently urinating)

Polyphagia (frequently hungry)

THE CLASSIC SYMPTOMS


5/19

DIAGNOSIS

Classic symptoms, weight loss,and random plasma glucose 200

mg/dL

Fasting plasma glucose 126mg/dL

Two hours post glucose load (75gr) plasma glucose 200 mg/dL,

and confirmed by repeat test.


6/19

TREATMENT

The goals of treatment is lifestyle changes, bloodsugar control, and medication treatment.


7/19

PROGNOSIS

Cardiovascular disease is the major source ofmortality in patients with type 2 diabetesmellitus.


8/19

STROKE

Stroke is the clinicalterm for acute lossof perfusion tovascular territory ofthe brain, resultingin ischemia and acorresponding loss

of neurologicfunction


9/19

PATHOGENESIS

Ischemic strokes result from events that limit or stopblood flow, such as embolism, thrombosis in situ, orrelative hypoperfusion. As blood flow decreases, neuronscease functioning, and irreversible neuronal ischemiaand injury begin at blood flow rates of less than 18mL/100 mg/min.

Within seconds to minutes of the loss of glucose andoxygen delivery to neurons, the cellular ischemic cascadebegins. This is a complex process that begins withcessation of the normal electrophysiologic function of

the cells. The resultant neuronal and glial injuryproduces edema in the ensuing hours to days afterstroke, causing further injury to the surrounding tissues.


10/19

SIGN AND SYMPTOMS

Symptoms of stroke depend on the amount ofblood involved and location of the stroke area inthe brain, there are include :

Sudden numbness or weakness of the face, armor leg (especially on one side of the body)

Sudden confusion, trouble speaking or

understanding speech Sudden trouble seeing in one or both eyes

Sudden trouble walking, dizziness, loss ofbalance or coordination

Sudden severe headache with no known cause


11/19

TEST AND DIAGNOSIS

Stroke is diagnosed through several techniquessuch as :

Family members may have a genetic tendency

for stroke or share a lifestyle that contributes tostroke.

Short neurological examination and blood test.

CT scan(without contrast enhancements) is the

most important imaging study at this time forstroke. A CT scan can help rule out ahemorrhagic stroke.

MRI, Doppler ultrasound, and arteriography.


12/19

TREATMENT

Emergency treatment for stroke depends onwhether the patients are having an ischemicstroke blocking an artery or a hemorrhagic

stroke involving bleeding into the brain. To treat an ischemic stroke, the doctors must

quickly restore blood flow to the brain.

Emergency treatment of hemorrhagic stroke

focuses on controlling bleeding and reducingpressure in the brain.


13/19

COMPLICATIONS

Acute complications occur within 72 hoursinclude cerebral edema, increased Intra

Cranial Pressure and possible herniation,hemorrhagic transformation, aspirationpneumonia, and seizures.

Postfibrinolytic complications center around

bleeding. Of greatest concern is intracerebralhemorrhage, typically occurring within thefirst 12 hours after treatment.


14/19

PROGNOSIS

The prognosis depending upon the premorbidcondition, stroke severity, age, and poststroke

complications.


15/19

THE RELATIONSHIP OF

HYPERGLYCEMIA AND STROKE

Diabetes is a prominent risk factor for acuteischemic stroke but not hemorrhagic stroke.

Patients with acute ischemic stroke frequentlytest positive for hyperglycemia, which isassociated with a poor clinical outcome


16/19

Hyperglycemic stroke results in increased neuronaldamage.

The mechanism is believed to be acceleratedatherosclerosis, which can affect vessels in manydistributions, including small and large vessels.

In addition, patients with diabetes may have any ofseveral lipid abnormalities.

Elevated levels of triglycerides, low-densitylipoproteins (LDL), and very low-densitylipoproteins (VLDL), along with lower than normallevels of high-density lipoprotein (HDL), are

common findings in the lipid profiles of patientswith diabetes. The combined effect of these factorsresults in promotion of atherosclerosis andthrombosis.


17/19


18/19

TREATMENT

In terms of primary prevention, treatment ofdiabetes appears to reduce the incidence ofatherosclerotic complications.

Intensive approaches to multiple risk factors instroke have been suggested, including reduction ofLDL (to below 100 mg/dL in diabetics), increase ofHDL (with fibrates if tolerated, an effect especially

beneficial in patients with insulin resistance

), tightglucose control, and hypertensive management. Typically, hyperglycemia in the setting of acute

stroke is treated with subcutaneous insulin in asliding scale


19/19

THANK S FOR YOUR ATTENTION

The Relationship of Hyperglycemia and Stroke

Documents

Transcript of The Relationship of Hyperglycemia and Stroke