title: Neuroanatomic correlates of poststroke hyperglycemia.
abstract: OBJECTIVE
  A study was undertaken to determine associations between ischemic stroke sites and poststroke hyperglycemia (PSH).
  
  
  METHODS
  Nondiabetic patients with first ever ischemic stroke confirmed by imaging were prospectively included. Blood glucose level (BGL), National Institute of Health Stroke Scale (NIHSS) score, and clinical parameters were assessed on admission. BGL was dichotomized for elevated versus normal levels using a cutoff value of >7.0 mmol/l. Clinical parameters were correlated with BGL and were compared between patient groups with elevated versus normal glucose values. A voxel-based lesion symptom mapping (VLSM) analysis adjusted for confounding variables was performed correlating sites of ischemic lesions with PSH.
  
  
  RESULTS
  Of 1,281 stroke patients screened, 229 (mean age = 66.3 ± 15.9 years) met the inclusion criteria. Patients with elevated BGL were older, had higher NIHSS scores, and had larger infarcts compared to those without elevated glucose levels. Spearman rank analysis showed correlations between BGL and age, infarct size, heart rate (HR), and NIHSS scores (p ≤ 0.05). The VLSM analysis adjusted for these confounding factors demonstrated associations between PSH and damaged voxels in right hemispheric insular and opercular areas.
  
  
  CONCLUSIONS
  The data indicate that damage in the right insulo-opercular areas contributes to PSH. The association between sympathetically mediated increase of HR and BGL suggests disinhibition of sympathetic outflow as a possible mechanism for PSH.
authors.affiliation: Departments of Neurology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Klemens
authors.initials: K
authors.lastname: Winder
authors.forename: Frank
authors.initials: F
authors.lastname: Seifert
authors.forename: Tessa
authors.initials: T
authors.lastname: Ohnemus
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Sauer
authors.forename: Stephan
authors.initials: S
authors.lastname: Kloska
authors.forename: Arnd
authors.initials: A
authors.lastname: Dörfler
authors.forename: Max J
authors.initials: MJ
authors.lastname: Hilz
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwab
authors.forename: Martin
authors.initials: M
authors.lastname: Köhrmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D001921:Brain / Q000378:metabolism* / Q000473:pathology*; D002545:Brain Ischemia / Q000175:diagnosis / Q000378:metabolism; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis* / Q000378:metabolism*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000378:metabolism*
chemical_list: D001786:Blood Glucose