PATTERN OF STROKE IN TYPE 2 DIABETIC SUBJECTS VERSUS NON DIABETIC SUBJECTS

Authors

  • Azra Zafar
  • Syed Khurram Shahid
  • Maimoona Siddiqui
  • Farrukh Shohab Khan

Abstract

Background: Diabetes mellitus is a well-recognized risk factor for ischaemic stroke. Stroke indiabetic patients is different from stroke in non-diabetics from several perspectives. There is nolocal study on this topic. This is the first study from Pakistan, in which pattern of stroke indiabetics have been described and compared with non-diabetics. The object of this study was tocompare pattern of stroke in diabetic subjects with non-diabetics. Methods: This is a prospectivecomparative cross sectional study, carried out at Liaquat national hospital, Karachi, neurologydepartment from October to March 2006. Fifty patients were enrolled in diabetic group and 50 innon-diabetic. Clinical features, risk factors and stroke patterns were identified. Results: Mean agewas 59.5 (±11.82) in diabetics and 60.4 (±14.8) in non diabetics. There was slight preponderanceof male patients in non diabetic group. Out of 50 diabetic patients, 44 (88.0%) had ischaemicstroke and 6 (12.0%) had intracerebral haemorrhage. In non-diabetics, 29 (58.0%) had ischaemicstroke while 21 (42.0%) had intracerebral haemorrhage. On further analysis of ischaemic stroke,cortical infarcts (CI) was found in 22, sub cortical infarcts (SCI) in 14, brainstem in 5 andcerebellar in 2 diabetic patients. CI was also the commonest subtype of ischaemic stroke in nondiabetics. Conclusion: Patterns of stroke in diabetics are different from non-diabetics. Ischaemicstroke is more prevalent than hemorrhagic stroke in diabetics. Sub cortical infarcts are morecommon in diabetics than non diabetics (p=0.04).Keywords: Stroke, diabetes mellitus, stroke pattern

References

Gordick PB, Sacco RL, Smith DB, Albert M, MustoneAlexander L, Rader D, et al. Prevention of a first stroke: a

review of guidelines and multidisciplinary consensus

statement from the National Stroke Association. JAMA

;281:1112–20.

Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes.

Other risk factors and 12-yr cardiovascular mortality for men

screened in the Multiple Risk Factor Intervention Trial.

Diabetes Care 1993;16: 434–44.

Jafari FH, Ahmed SI, Qureshi HA. Presentation, progression

and prognosis of stroke in Hypertensives, the Diabetic and

the Normotensive Normoglycemic. J Rawalpindi Med Coll

;4:47–9.

Khealani BA, Syed NA, Maken S, Mapari UU, Hameed B,

Ali S, et al. Presence of diabetes mellitus and ischemic heart

disease predict ischemic stroke in a patient with

hypertension. .J Coll Physicians Surg Pak 2005;15:22–5.

UKPDS Group. Association of systolic blood pressure with

macrovascular and microvascular complications of type 2

Diabetes (UKPDS 36). BMJ 2000;321:412–9.

Grau AJ, Weimer C, Buggle F, Heinrich A, Goetler M,

Neumaier S, et al. Risk factors, outcome,, and treatment in

subtypes of ischemic stroke. The German stroke data bank.

Stroke 2001;32:2559–66.

Rodriguez BL, D’ Agostino R, Abbott RD, Kagan A,

Burchfiel CM, Yano K, et al. Risk of hospitalized stroke in

men enrolled in Honolulu Heart Program and the

Framingham Study: A comparison of incidence and risk

factor effects. Stroke 2002;33:230–6.

Njolstad I, Arnesen E, Lund-Larsen PG. Body height,

cardiovascular risk factors, and risk of stroke in middle- aged

men and women. A14- year follow-up of the Finnmark study.

Circulation 1996;94:2877–82.

Karapanayiotides T, Piechowski-Jozwiak B, van Melle G,

Bogousslavasky J, Devuyst G. Stroke patterns, etiology, and

prognosis in patients with diabetes mellitus. Neurology

;62:1558–62.

Syed NA, Khealani BA, Ali S, Hasan A, Akhtar N, Brohi H,

et al. Ischemic stroke subtypes in Pakistan: the Aga Khan

University Data Bank. J Pak Med Assoc 2003;53:584–8.

Abbott RD, Donahue RP, MacMahan SW, Reed DM, Yano

K. Diabetes and the risk of stroke: the Honolulu Heart

Program. JAMA 1987;257:949–52.

Tuomilehto J, Rastenyte D, Jousilahti P, Sarti C, Vartiainen

E. Diabetes mellitus as a risk factor for death from stroke.

Prospective study of the middle-aged Finnish population.

Stroke 1996;27:210–15.

Basir F, Ali S, Aziz H. Stroke recovery and outcome in

diabetes. J Coll Physicians Surg Pak 2001;11:736–8.

Megherbi S-E, Milan C, Minier D, Couvreur G, Osseby G-V,

Tilling K, et al. Association between diabetes and stroke

subtypes on survival and functional outcome 3 months after

stroke. Data from the European BIOMED Stroke Project.

Stroke 2003;34:688–94.

Sarkar RN, Banarjee S, Basu A. Comparative evaluation of

diabetic and non- diabetic stroke--effect of glycemia on

outcome. J Indian Med Assoc 2004;102:551–3.

Jorgensen H, Nakayma H, Raaschou HO, Oslen TS. Stroke

in patients with diabetes. The Copenhagen Stroke Study.

Stroke 1994;25:1977–84.

Kiessla BM, Khoury J, Kleindorfer D, Woo D, Schneider A,

Alwell K, et al. Epidemiology of ischemic stroke in patients

with diabetes: the greater Cincinnati/Northern Kentucky

Stroke Study. Diabetes Care 2005;28:355–9.

Aronson SM. Intracranial vascular lesion in patients with

diabetes mellitus. J Neuropathol Exp Neurol 1973;32:183–96.

Stegmayr B, Asplund K. Diabetes as a risk factor for stroke.

A population perspective. Diabetologia 1995;38:1061–8.

Fritz VU, Bilchik T, Levien LJ. Diabetes as a risk factor for

transient ischemic attacks opposed to stroke. Eur J Vasc Surg

;1:259–62.

Mankovsky BN, Zeigler D. Stroke in patients with diabetes

mellitus. Diabetes Metab Res Rev 2004;20:268–87.

Ghika A, Bogousslavsky J, Regli F. Infarcts in the territory

of the deep perforators from the carotid system. Neurology

;39:507–12.

Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW,

Kistler JP, et al. The Harvard Cooperative Stroke Registry: A

prospective registry. Neurology 1978;28:754–62.

Baliga BS, Weinberger J. Diabetes and stroke: part one—risk

factors and pathophysiology. Curr Cardiol Rep 2006;8:23–8.

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