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THE RELATIONSHIP OF
HYPERGLYCEMIA AND STROKE
INA JULIA SARI
030.07.114
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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.
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PATHOGENESIS
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THE SYMPTOMS
Polydipsia (frequently thirsty)
Polyuria (frequently urinating)
Polyphagia (frequently hungry)
THE CLASSIC SYMPTOMS
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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.
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TREATMENT
The goals of treatment is lifestyle changes, bloodsugar control, and medication treatment.
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PROGNOSIS
Cardiovascular disease is the major source ofmortality in patients with type 2 diabetesmellitus.
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STROKE
Stroke is the clinicalterm for acute lossof perfusion tovascular territory ofthe brain, resultingin ischemia and acorresponding loss
of neurologicfunction
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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.
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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
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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.
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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.
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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.
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PROGNOSIS
The prognosis depending upon the premorbidcondition, stroke severity, age, and poststroke
complications.
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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
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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.
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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
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THANK S FOR YOUR ATTENTION