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Vol. 34, No. 5-6, 2012
Issue release date: December 2012
Cerebrovasc Dis 2012;34:406–410
(DOI:10.1159/000343654)

Ischemic Vagus Nuclei Lesions and Hyperglycemia: A Study in 26 Patients with Lateral Medullary Infarction and Matched Controls

Ruano L. · Alves I. · Barreto R. · Araújo I. · Veira C. · Cruz V.T.
aNeurology Department, Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, and bSecção Autónoma de Ciências da Saúde, Universidade de Aveiro, Campus Universitário de Santiago, Aveiro, Portugal

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Abstract

Background: Hyperglycemia is common after stroke in diabetic and nondiabetic patients. Furthermore, it has been associated with infarct expansion, worse functional outcomes and higher mortality. In a previous study, infarction of the insular region was related to higher poststroke glucose levels than infarcts in other cortical areas. Experimental studies in animal models suggested that the lower brainstem nuclei of the vagus nerve modulate insulin secretion. These nuclei are usually affected in lateral medullary infarction (LMI). We evaluated whether patients with lateral medullary stroke have worse poststroke glycemic control than other stroke patients. Methods: A hospital-based stroke registry was used to identify 26 patients from the years 2000 to 2010 who fulfilled the following inclusion criteria: (1) a first-ever stroke; (2) neurological deficits compatible with LMI; (3) MRI confirmation of an ischemic lesion of the lateral medulla involving the vagus nerve nuclei, and (4) no simultaneous infarcts. Patients were excluded if they were admitted to the hospital more than 24 h after stroke onset or died in the first 24 h after hospital admission. A control group of other stroke patients was randomly selected from the same stroke registry and over the same time period, matching for the age and gender of the LMI group. The average glycemia was compared between the two groups using a linear regression model adjusted for confounders. Glycated hemoglobin at admission was used to estimate prestroke glycemic control. Prestroke glycemic averages were then compared with poststroke glycemia for the two groups using the Wilcoxon signed test for related samples. Results: The average glycemia of the LMI patients in the first 24 h after stroke was 9.4 mmol/l (SD 3.2), and from 24 to 72 h it was 7.6 mmol/l (SD 2.8). In the comparison group, these values were 7.7 (SD 2.8) and 7.1 mmol/l (SD 2.7), respectively. As expected, diabetic patients had a significantly higher glycemia than nondiabetic patients (p < 0.0001). The adjusted linear regression model showed the average glycemia differences to be significant for the first 24 h (p = 0.001; R2 = 55.6%) but not for the 24– 72 h period. The frequency of previous diabetes mellitus was similar in both groups. As compared to prestroke glycemic estimates, glycemia in lateral medullary stroke patients increased significantly more than in controls during the first 24 h after stroke (p = 0.01), but again there were no significant differences for the 24–72 h period. Conclusions: This study suggests that ischemic lesions of the vagus nerve nuclei are associated with worse early poststroke glycemic control than stroke in other locations. Confirmation of this hypothesis and the long-term implications of glucose control impairment warrant further prospective studies.



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References

  1. Scott JF, Robinson GM, French JM, O’Connell JE, Alberti KG, Gray CS: Prevalence of admission hyperglycaemia across clinical subtypes of acute stroke. Lancet 1999;353:376–377.
  2. Baird TA, Parsons MW, Phanh T, Butcher KS, Desmond PM, Tress BM, Colman PG, Chambers BR, Davis SM: Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome. Stroke 2003;34:2208–2214.
  3. Els T, Klisch J, Orszagh M, Hetzel A, Schulte-Monting J, Schumacher M, Lucking CH: Hyperglycemia in patients with focal cerebral ischemia after intravenous thrombolysis: influence on clinical outcome and infarct size. Cerebrovasc Dis 2002;13:89–94.
  4. Hu GC, Hsieh SF, Chen YM, Hsu HH, Hu YN, Chien KL: Relationship of initial glucose level and all-cause death in patients with ischaemic stroke: the roles of diabetes mellitus and glycated hemoglobin level. Eur J Neurol 2012;19:884–891.
  5. Yong M, Kaste M: Dynamic of hyperglycemia as a predictor of stroke outcome in the ECASS-II trial. Stroke 2008;39:2749–2755.
  6. Putaala J, Sairanen T, Meretoja A, Lindsberg PJ, Tiainen M, Liebkind R, Strbian D, Atula S, Artto V, Rantanen K, et al: Post-thrombolytic hyperglycemia and 3-month outcome in acute ischemic stroke. Cerebrovasc Dis 2011;31:83–92.
  7. De Silva DA, Ebinger M, Christensen S, Parsons MW, Levi C, Butcher K, Barber PA, Bladin C, Donnan GA, Davis SM: Baseline diabetic status and admission blood glucose were poor prognostic factors in the EPITHET trial. Cerebrovasc Dis 2010;29:14–21.
  8. Allport LE, Butcher KS, Baird TA, MacGregor L, Desmond PM, Tress BM, Colman P, Davis SM: Insular cortical ischemia is independently associated with acute stress hyperglycemia. Stroke 2004;35:1886–1891.
  9. Burcelin R: The gut-brain axis: a major glucoregulatory player. Diabetes Metab 2010;36(suppl 3):S54–S58.
  10. Bereiter DA, Berthoud HR, Brunsmann M, Jeanrenaud B: Nucleus ambiguus stimulation increases plasma insulin levels in the rat. Am J Physiol 1981;241:E22–E27.
  11. Mussa BM, Sartor DM, Rantzau C, Verberne AJ: Effects of nitric oxide synthase blockade on dorsal vagal stimulation-induced pancreatic insulin secretion. Brain Res 2011;1394:62–70.
  12. Kumral E, Kisabay A, Atac C, Calli C, Yunten N: Spectrum of the posterior inferior cerebellar artery territory infarcts. Clinical-diffusion-weighted imaging correlates. Cerebrovasc Dis 2005;20:370–380.
  13. Kim JS: Pure lateral medullary infarction: clinical-radiological correlation of 130 acute, consecutive patients. Brain 2003;126:1864–1872.
  14. Allport L, Baird T, Butcher K, Macgregor L, Prosser J, Colman P, Davis S: Frequency and temporal profile of poststroke hyperglycemia using continuous glucose monitoring. Diabetes Care 2006;29:1839–1844.
  15. Rohlfing CL, Wiedmeyer HM, Little RR, England JD, Tennill A, Goldstein DE: Defining the relationship between plasma glucose and HbA(1c): analysis of glucose profiles and HbA(1c) in the Diabetes Control and Complications Trial. Diabetes Care 2002;25:275–278.


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