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Clinical and evolutive glycemic peculiarities in patients with acute ischemic stroke. Prognosis and Treatment.


Author: Grigor Viorel
Degree:doctor of medicine
Speciality: 14.00.13 - Neurology
Year:2009
Scientific adviser: Stanislav Groppa
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Valentin Gudumac
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution: State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific council: DH 50-14.00.13
State University of Medicine and Pharmacy "Nicolae Testemitanu"

Status

The thesis was presented on the 15 April, 2009
Approved by NCAA on the 18 June, 2009

Abstract

Adobe PDF document0.38 Mb / in romanian

Keywords

stroke, cerebral ischemia, hyperglycemia, normoglycemia, insulin, glycemic modulation, insulin resistance, dismetabolic syndrome, oxidative stress

Summary

The vascular cerebral accidents constitute an acute medical-social problem for the well-developed countries and those that are economically under way they are situated on the second place due, to mortality and on the first place due to the handicap in the adults. A lot of patients have an increased glycemic level that could harm the patient taking into consideration the volume of cerebral infarct, neurologic deficit and functional recoveries.

A study has been made on 108 patients with acute ischemic stroke, they were selected according to the specific of a group of 712 patients. The patients were divided in 3 groups: I group – 41 patients with stroke and hyperglycemia, with conventional treatment; II group – 32 patients with stroke and hyperglycemia and that were treated with insulin perfusion, and III group – 35patients with stroke and normoglycemia.

During a moth it has been studied the clinical features of the patients in relation with the glycemic at the moment of hospitalization and the influence of the Insulin intravenous treatments on lethality, the complications and prognosis. Glycemia was studied in dynamic, the correlation of glycemia whit the oxidation stress and the main factors of risk.

So, we can see that in the many cases, the hospitalized patients with ischemic stroke (49,6%) have a slight or moderate elevation of glycemia (>6,0 mmol/l), even in the patients without glycemic disturbances in the past.

Patients with ischemic stroke, hyperglycemia and Insulin treatment had a lethality of 6,25% in comparison with the other with hyperglycemia without Insulin treatment - 22%.The period of hospitalization in the intensive therapy room is shorter for the patients treated with Insulin (2,83±2,2 vs 7,08±4,7, p<0,001).

The administration of Insulin proved the reduction of the oxidation system activity and a concomitant rise antyoxidation system activity.

The appreciation and management of hyperglycemia is indicated and it has to be administrated to all the patients with ischemic stroke as soon as possible. The appreciation and monitorization in dynamic can be done easily and fast by the glycometre.

In conclusion we can mention that the association of the ischemic AVC with hyperglycemia leads to a more severe clinical evolution with a higher level of a 3,5, and with a poor neurologic recovery .The hyperglycemia in the ischemic stroke is not a benign condition, it needs a modulation of glycemia with insulin intravenous perfusion at least during the “ therapy window”.