Broderick J P, Hagen T, Brott T, Tomsick T
Department of Neurology, University of Cincinnati Medical Center, OH 45267-0525.
Stroke. 1995 Mar;26(3):484-7. doi: 10.1161/01.str.26.3.484.
Identification of factors that predispose to bleeding into ischemic brain could lead to safer use of thrombolytic agents in the setting of ischemic stroke. Recently de Courten-Meyers and colleagues reported that occluding the middle cerebral artery of markedly hyperglycemic cats was associated with 5-fold more frequent and 25-fold more extensive hemorrhage into infarcts than in normoglycemic animals. Hemorrhage associated with hyperglycemia in cats was much more pronounced with reperfusion than with permanent middle cerebral artery occlusion.
We describe two patients with a unique presentation of diffuse hemorrhagic infarction of the caudate and lentiform nuclei associated with initially marked hyperglycemia and the subsequent development of hemichorea.
We hypothesize that the marked hyperglycemia due to poor control of diabetes contributed to the hemorrhagic change of the caudate and lenticular nuclei. Because the hemorrhage in hyperglycemic cats was more pronounced in the setting of reperfusion, hemorrhagic risk associated with hyperglycemia should be investigated, particularly in ongoing thrombolytic treatment trials for acute ischemic stroke. We encourage other acute stroke investigators to prospectively look at the risk of brain hemorrhage in stroke patients with marked hyperglycemia.
确定易导致缺血性脑内出血的因素，有助于在缺血性卒中情况下更安全地使用溶栓药物。最近，德·库尔滕 - 迈耶斯及其同事报告称，与血糖正常的动物相比，阻断明显高血糖猫的大脑中动脉后，梗死灶内出血的频率高出5倍，出血量多出25倍。猫中与高血糖相关的出血在再灌注时比永久性大脑中动脉闭塞时更为明显。
我们描述了两名患者，其表现为独特的尾状核和豆状核弥漫性出血性梗死，最初伴有明显高血糖，随后出现偏身舞蹈症。
我们推测，糖尿病控制不佳导致的明显高血糖促成了尾状核和豆状核的出血性改变。由于高血糖猫在再灌注时出血更为明显，因此应研究与高血糖相关的出血风险，尤其是在急性缺血性卒中正在进行的溶栓治疗试验中。我们鼓励其他急性卒中研究人员前瞻性地观察明显高血糖的卒中患者发生脑出血的风险。
