Hyperglycemia in aneurysmal subarachnoid hemorrhage: a potentially modifiable risk factor for poor outcome.
Hyperglycemia after aneurysmal subarachnoid hemorrhage (aSAH) occurs frequently and is associated with delayed cerebral ischemia (DCI) and poor clinical outcome. In this review, we highlight the mechanisms that cause hyperglycemia after aSAH, and we discuss how hyperglycemia may contribute to poor clinical outcome in these patients. As hyperglycemia is potentially modifiable with intensive insulin therapy (IIT), we systematically reviewed the literature on IIT in aSAH patients. In these patients, IIT seems to be difficult to achieve in terms of lowering blood glucose levels substantially without an increased risk of (serious) hypoglycemia. Therefore, before initiating a large-scale randomized trial to investigate the clinical benefit of IIT, phase II studies, possibly with the help of cerebral blood glucose monitoring by microdialysis, will first have to improve this therapy in terms of both safety and adequacy.
Kruyt
Nyika D
ND
Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. N.D.Kruijt@amc.uva.nl
Biessels
Geert Jan
GJ
DeVries
J Hans
JH
Luitse
Merel J A
MJ
Vermeulen
Marinus
M
Rinkel
Gabriel J E
GJ
Vandertop
W Peter
WP
Roos
Yvo B
YB
D000818:Animals; D001786:Blood Glucose / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000628:therapy*; D017211:Treatment Failure
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin