Raghavan, K S (2012) Clinical Outcome of Stroke in relation to Admission Day Glycemic Status. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Among all the neurological diseases of adult life, cerebrovascular accidents clearly ranks first in frequency of importance. Atleast fifty percent of neurological diseases in general hospital are due to stroke. Cerebrovascular accident includes ischemic stroke, hemorrhagic stroke, and cerebrovascular anomalies such as intracranial aneurysm, AV malformation and cortical venous thrombosis. Stroke, after heart disease and cancer, is the third most common cause of death. With the introduction of effective treatment for hypertension, there has been a marked reduction in the frequency of stroke. Diabetes mellitus by virtue of its association with micro vascular and macrovascular complications is an important risk factor in the genesis of stroke. Most of the diabetic patients with stroke have raised glycosylated haemoglobin indicating that most of them have uncontrolled diabetes. Diabetics and stress hyperglycemics have severe strokes resulting in poor outcome. Stroke is twice more common in diabetics than in non diabetics. Hypertension is common in diabetes and accelerates atherosclerosis which promotes intracranial small vessel disease and heart disease leading to lacunar and embolic infarction respectively. There are several risk factors that determine the outcome of stroke hyperglycemia at presentation, hypertension, hypothermia, fever are those which are widely studied. AIM AND OBJECTIVES: To measure the blood glucose level within twenty four hours of the onset of stoke in both diabetics and in non diabetics and to evaluate the severity and prognosis in both diabetics and non diabetics in relation to hyperglycemia. MATERIALS AND METHODS: A total of hundred and eleven patients of acute stroke admitted in the department of medicine Government Rajaji Hospital Madurai between April 2011 and September 2011 were studied. The patients were selected on the following basis Inclusion Criteria: 1. Patients above 40 years. 2. Patients admitted within twenty four hours of onset of symptoms. 3. Patients should not be a known case of cerebro vascular accident. 4. Blood sugar recorded with in twenty four hours of the onset of stroke. Exclusion Criteria: 1. Patients admitted after twenty four hours of stroke. 2. Those patients who received intravenous glucose before or during study period. 3. Patients for whom information about diabetes could not be obtained. 4. Patients who died before it could be established whether or not they had diabetes. 5. Illness presented with stroke like symptoms. Out of the hundred and eleven patients, eleven were dropped as follow up could not be done. CONCLUSION: There is a linear correlation between admission day hyperglycemia and stroke in its severity, size and outcome. The combined diabetes and stress hyperglycemics are found to have larger sized severe stroke and poor functional outcome in the form of increased mortality. There is a good correlation between admission day glucose level and the outcome in ischemic stroke. Admission day elevated glucose level was a significant predictor of mortality and poor functional outcome after acute stroke. Hence, restoration of normoglycemia as soon as possible should be encouraged though conclusive evidences are lacking. In the interim, we should fare well with adhering to good general stroke management, normalization of body temperature, fluid balance and hemodynamics or we may otherwise risk the favorable outcome even in the patients with normoglycemia.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Clinical Outcome ; Stroke ; Admission Day ; Glycemic Status. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 20 Mar 2018 02:35 |
| Last Modified: | 20 Mar 2018 02:35 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6374 |
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