CEREBRAL INFARCTION IN DIABETICS: PATTERNS AND PREDICTORS OF HOSPITAL MORTALITY

This study was done to assess the relation between diabetes mellitus and ischeamic stroke regarding clinical patterns and hospital mortality.This study included 380 patients presenting with acute ischeamic stroke, 120 were diabetic and 260 were not diabetic.All were subjected to the following:1- Detailed history taking.2- Complete general and neurological examination.3- Assessment of stroke severity using GCS and C.A.N.S for daily follow-up and MRS on the first and tenth day of admission to evaluate functional outcome.4- Laboratory investigations including glycosylated haemoglobin, random, fasting and postprandial blood sugar liver and kidney functions, lipid profile, complete blood count and uric acid level.5- Computed tomography of the brain.6- ECHO and ECG.- This results showed that:1- The age of our diabetic patients was younger than non diabetic.2- The incidence of ischemic stroke in hypertensive patients is higher than the other risk factors (hypertension > smoking > AF > TIA > hyperlipideamia and MI > obesity).3- The number of NIDDM was higher than IDDM patients.4- There was positive correlation between admission glucose level and HbA1c level and clinical presentation by CANS and MRS.5- Dysarthria, pure motor, pure sensory and sphincteric disturbance were higher in diabetic group.6- The size of infarctions were more medium and small size (lacunar) in our diabetic patients.7- Occipital lobe and thalamic infarctions were significantly higher in our diabetic group, while frontal infarction were higher in nondiabetic group.8- There was no significant difference between both types of diabetes regarding the clinical outcome by MRS.9- Outcome using MRS was more worse in diabetic indicting increasing disability and mortality.10- Causes of deterioration were heamorrhagic transformation, infarct expansion and stroke recurrence. In our diabetic group infarct expansion and stroke recurrence were higher than nondiabetic one.11- Mortality was higher in non diabetic group.12- Causes of mortality varies between infection, cardiac diseases.