Recent glycemic control can predict the progressive motor deficits of acute subcortical infarction with diabetes or pred
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ORIGINAL ARTICLE
Recent glycemic control can predict the progressive motor deficits of acute subcortical infarction with diabetes or prediabetes Kayeong Im 1 & Hyunjin Ju 1 & Mina Lee 1 Hye-Won Hwang 1 & Kyung Bok Lee 1
&
Byung-Euk Joo 1 & Kyum-Yil Kwon 1 & Hakjae Roh 1 & Moo-Young Ahn 1 &
Received: 16 February 2020 / Accepted: 27 July 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Background and purpose The predictors of progressive motor deficits in acute subcortical infarctions are still controversial. It is not known whether glycemic control influences on stroke progression. Methods A total of 268 consecutive patients with diabetes or prediabetes who had acute (< 24 h) subcortical infarction were enrolled. (1) All patients were divided into 4 groups by quartile of glycated hemoglobin (HbA1c). (2) Only the patients with diabetes were divided by effective glycemic control. Progressive motor deficits were prospectively captured and defined as an increase of motor score ≥ 1 on the upper or lower limb items of the National Institute of Health Stroke Scale within 72 h from stroke onset. Results Progressive motor deficits occur in 8/78 (10.3%) for ≤ 5.9, 15/61 (24.6%) for 6.0–6.4, 16/62 (25.8%) for 6.5–7.4, and 30/ 67 (44.8%) for ≥ 7.5. In diabetic patients alone, those occur in 5/37 (13.5%) for ≤ 6.5, 10/42 (23.8%) for 6.6–7.0, 12/42 (28.6%) for 7.1–8.0, and 24/50 (48.0%) for ≥ 8.1. An adjusted OR of progressive motor deficits was 2.61 (95% confidence interval [CI] 0.98–7.00, P = .056) for 6.0–6.4, 3.42 (95% CI 1.27–9.18, P = .015) for 6.5–7.4, and 6.65 (95% CI 2.38–18.62, P < .001) for ≥ 7.5. In diabetic patients alone, those were 3.15 (95% CI 0.89–11.15, P = .075) for 6.6–7.0, 2.90 (95% CI 0.79–10.61, P = .107) for 7.1–8.0, and 4.17 (95% CI 1.07–16.25, P = .038) for ≥ 8.1. The optimal cutoff value of HbA1c was 6.65% in discriminating progressive motor deficits. Conclusion Increased HbA1c was associated with higher incidence of progressive motor deficits in acute subcortical infarction with diabetes and prediabetes. Keywords Acute stroke . Cerebral infarction . Glucose . Diabetes mellitus
Introduction Acute subcortical infarction (ASI) accounts for more than a quarter of the total ischemic strokes [1, 2]. Between 20 and 70% of patients with ASI experience an early neurologic deterioration and fluctuations during the first week after stroke onset [3–5], which is much higher than acute non-subcortical infarction [6, 7]. The worsening of motor deficits in ASI is a major cause of poor functional outcomes and complications [8]. Branch atheromatous
* Kyung Bok Lee [email protected] 1
Departments of Neurology, Soonchunhyang University School of Medicine, 59 Daesakwan-ro, Yong san-gu, Seoul 04401, South Korea
disease, a plaque in the parent artery or by a microatheroma at the origin of a branch, is supposed to play an important role in the pathophysiology of stroke progression in ASI [9, 10]. Among many factors affecting the progression of ASI, diabetes has been most commonly reported, and this may
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