title: Occurrence and clinicotopographical correlates of brainstem infarction in patients with diabetes mellitus.
abstract: BACKGROUND
  The goal of the study was to clarify the association between diabetes mellitus (DM) and brainstem infarctions (BSIs) and to investigate the clinicotopographic characteristics of BSIs in patients with diabetes.
  
  
  METHODS
  Data were retrospectively reviewed for 1026 consecutive patients admitted to our hospital because of acute cerebral infarctions from January 2004 to August 2010. Acute symptomatic BSIs were explored on radiologic images and classified into multiple infarctions with BSIs, multifocal BSIs, and monofocal BSIs. Isolated BSIs were further classified based on the vertical distribution into midbrain, pontine, and medullary infarctions, and on the horizontal distribution into anterior-dominant, posterior-dominant, and anterior/posterior BSIs. Neurologic symptoms of BSIs and clinical background were compared between DM and non-DM patients.
  
  
  RESULTS
  The prevalence of BSIs was 2.6-fold higher (P < .0001) in DM patients. Logistic regression analysis including age, sex, smoking, previous stroke, atrial fibrillation, other cardiac diseases, hypertension, hyperlipidemia, and DM showed that DM was independently associated with BSIs (odds ratio [OR] 2.814; 95% confidence interval [CI] 1.936-4.090; P < .0001). Compared with non-DM patients, DM patients showed more frequent monofocal BSIs (P < .0001) and multifocal BSIs (P = .0296). Monofocal BSIs (n = 114) more frequently involved the pons (P < .0001) and medulla (P = .0212). Anterior-dominant BSIs (P < .0001) were more common in DM patients than in non-DM patients. Symptoms of BSIs included more frequent motor paresis (P = .0180) and less frequent diplopia (P = .0298) in DM patients than in non-DM patients.
  
  
  CONCLUSIONS
  DM is important in the development of BSIs, and the associated clinical characteristics include more frequent motor paresis and less frequent diplopia.
authors.affiliation: Department of Neurology, Showa University Fujigaoka Hospital, Yokohama, Japan. h_ichikawa0527@yahoo.co.jp
authors.forename: Hiroo
authors.initials: H
authors.lastname: Ichikawa
authors.forename: Ayako
authors.initials: A
authors.lastname: Kuriki
authors.forename: Ryuta
authors.initials: R
authors.lastname: Kinno
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Katoh
authors.forename: Masanori
authors.initials: M
authors.lastname: Mukai
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kawamura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001933:Brain Stem / Q000473:pathology* / Q000503:physiopathology; D020526:Brain Stem Infarctions / Q000145:classification / Q000453:epidemiology* / Q000473:pathology* / Q000503:physiopathology; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004172:Diplopia / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D016017:Odds Ratio; D010291:Paresis / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult