Background Stroke

Stroke is a heterogeneous disorder and can be divided into ischemic stroke (80%), primary intracerebral hemorrhagic stroke (15%), and subarachnoid hemorrhage (5%).

Ischemic stroke can be further divided based on etiology into cardioem-bolic, artery-to-artery embolism, so-called large vessel, or in situ small-vessel (or lacunar) stroke.

Known major risk factors for ischemic stroke include hypertension, diabetes mellitus (DM), smoking, and atrial fibrillation. The major risk factor for primary intracerebral hemorrhage is hypertension (60-70% of patients). The remaining patients may have intracranial vascular malformations (cavernous angiomas or arteriovenous malformations) or cerebral amyloid angiopathy as the cause of the bleeding.

In the past 10-15 years, major advances have been made in the acute management of stroke. Most notably, the routine management of patients in stroke care units and specifically the use of thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) within 3 h and the administration of oral aspirin within 48 h of ischemic stroke have contributed to improved outcome. Despite this, stroke remains the second most common cause of death and the major cause of disability worldwide, and it is one of the major contributors to health-care costs in the industrialized countries (1).

Therefore, it remains of major importance to improve the treatment options for patients suffering from a stroke. Modifiable factors, associated with poor outcome after stroke, such as hyperglycemia, have the potential for being new treatment targets.

One of the drawbacks when reviewing the literature on hyperglycemia in acute stroke is that the distinction between stroke subtypes is not always clearly defined. Moreover, the definition of hyperglycemia varies substantially from study to study. In this chapter we will mainly focus on hyper-glycemia after ischemic stroke and just briefly discuss about other stroke subtypes. Concerning the definition of hyperglycemia, we adopted the definition used in each separate study.

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