Hyperglycaemia and neurological injury.
OBJECTIVE
Clinical and experimental data suggest that hypergylcaemia lowers the ischaemic neuronal threshold and worsens outcome in the presence of neurological injury from trauma, stroke and subarachnoid haemorrhage. This review aims to appraise the evidence for tight glycaemic control in patients with neurological injury.


RESULTS
Hyperglycaemia can adversely affect outcome in critically ill patients. Intensive insulin therapy with tight glycaemic control has been advocated for improving outcome in these patients. However, the extent to which intensive insulin therapy and tight control of blood glucose improve outcome after ischaemic neurological insults remains unclear. The benefit of such treatment regimes may be negated by the increased frequency of hypoglycaemic episodes, which may aggravate neurological injury. Although it seems sensible to control hyperglycaemia in patients with neurological injury, the treatment must account for potential hypoglycaemic episodes.


CONCLUSIONS
Clinical and experimental data suggest that hyperglycaemia lowers the ischaemic neuronal threshold in the presence of neurological injury. Tight glycaemic control may result in hypoglycaemia, which in itself can be detrimental. Therefore, it seems sensible that we should accept slightly less tight blood glucose control than in the critically ill patient without neurological injury.
Prakash
Amit
A
Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK.
Matta
Basil F
BF
D000758:Anesthesia / Q000009:adverse effects*; D001786:Blood Glucose / Q000378:metabolism; D001930:Brain Injuries / Q000150:complications / Q000378:metabolism; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000378:metabolism; D007511:Ischemia / Q000150:complications / Q000378:metabolism; D009422:Nervous System Diseases / Q000150:complications* / Q000378:metabolism; D011379:Prognosis; D013119:Spinal Cord Injuries / Q000150:complications / Q000378:metabolism; D020521:Stroke / Q000150:complications / Q000378:metabolism; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000378:metabolism; D016896:Treatment Outcome
D001786:Blood Glucose