Melnyk V. Clinical manifestations and prognostic value of stress hyperglycaemia in post acute period to patients with pancreatic diabetes and without it.

According to the results of clinical neurological, magnetic resonance tomography and biochemical examination of 128 patients with hyperglycaemia (HG) in ischemic stroke acute period there was revealed a close correlation between dimension and localization of acute cerebral infarction and development of post stroke stress hyperglycaemia. In most cases it manifested after focal ischemic stroke of high and middle severity to patients with pancreatic diabetes and without it. The acute hyperglycaemia to patients with pancreatic diabetes is more often manifested after development of territorial ischemic stroke in carotid basin of corticosubcortical localization; within the group of patients with stress hyperglycaemia we observed the increase of a number of patients with vertebral basilar basin artery injury, proving the role of stem structures, dysfunction of vegetative centres of hypothalamus and stroke-inducted activation of hypothalamus hypophysial area blood-supplied by vertebral basilar system, development of hyperglycaemia to patients without pancreatic diabetes. Neurological functions to patients in post-acute ischemic stroke period accompanied with stress hyperglycaemia in the context of traditional therapy recovered slower than to patients with pancreatic diabetes: during first seven days their general condition was heavy and in most cases during first three days there was even increase of neurological deficit. It has been proved that the stress HG in post acute ischemic stroke period is an important prognostic factor of unsatisfactory recovery of neurological functions and prolongs time of hospitalization of patients with pancreatic diabetes (PD) and without it. Acute hyperglycaemia except for metabolic disorders was accompanied with cerebral homodynamic disorders, considerable decrease of blood circulation in area of ischemia focus, the tendency of these changes was identical to patients with ischemic stroke with stress hyperglycaemia in the context of pancreatic diabetes and without it: a considerable increase of maximum and medium blood circulation especially in the basin of medial cerebral artery in the area of damaged cerebral hemisphere. A proposed way of glucose metabolism correction in acute period of ischemic stroke improved clinical results of treatment: prevented increase of neurological deficit to patients with stress HG without PD; definitely improved the level of rehabilitation, increased the factors of functional state in post 3 months cerebral infarction period to patients with PD and without it.