[Cerebral vascular pathology in diabetes].
Diabetes is a major risk factor for cerebral vascular accidents (CVA) and the prevalence of diabetes in the population of patients presenting with CVA varies from 13 to 36% in studies. On the other hand, it is not a risk factor for haemorrhagic CVA. The two principal causes of CVA in diabetic patients are small artery disease and atherosclerosis of cervical and intracranial arteries. Diabetics differ from non-diabetics with a higher prevalence of hypertension. The data from the literature suggest a worse prognosis for CVA in diabetics. While the initial stroke severity seems comparable, the acute and especially late mortality is increased in diabetics. In those who survive, diabetics have a slower recovery and greater handicap at 3 months post CVA. Management in the acute phase of cerebral infarction is identical in the diabetic and non-diabetic. In secondary prevention, carotid surgery is indicated for stenoses of more than 50%; treatment of risk factors is the same. On the other hand, clopidogrel seems to be of more benefit than aspirin in diabetics. In conclusion, although there are aetiological and prognostic characteristics of diabetics presenting with a CVA, the treatment and its benefits in the acute phase and in secondary prevention are comparable.
Arquizan
C
C
Service de neurologie, hôpital Sainte-Anne, Paris. arquizan@ch-sainte-anne.fr
D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000628:therapy; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D012307:Risk Factors