Impact of acute and chronic hyperglycemia on volume and location of acute ischemic stroke: computed tomography data

Background. Acute ischemic stroke remains one of the leading causes of mortality and disability worldwide. Metabolic disturbances, particularly diabetes mellitus and hyperglycemia, play a significant role in disease progression, as they are associated with more severe brain tissue injury and poorer clinical outcomes. Neuroimaging is a key tool for the early diagnosis of acute stroke and determining subsequent therapeutic strategies. The use of the ASPECTS and pc-ASPECTS enables objective assessment of morphological brain tissue changes and prediction of clinical course, highlighting the relevance of investigating the impact of carbohydrate metabolism disorders on the characteristics of ische­mic stroke. Objective: to determine the features of neuroima­ging chan­ges in acute ischemic stroke depending on carbohydrate metabolism status. Materials and methods. A total of 124 patients with acute ischemic stroke were enrolled in this prospective study. Accor­ding to glycemic status, they were divided into three groups: those with type 2 diabetes mellitus (n = 63), transient hyperglycemia (n = 31), and a control group without carbohydrate metabolism disorders (n = 30). The location of ischemic lesions and ischemic core volume were analyzed using the ASPECTS and pc-ASPECTS. Statistical processing was performed using the χ2 test; p < 0.05 was considered statistically significant. Results. The distribution of stroke according to vascular territories and arterial segments did not depend on glycemic status (p > 0.05). The middle cerebral artery territory was most frequently affected, with a predominance of distal M2 and M3 segments. Statistically significant differences were found in the ASPECTS among the groups (p < 0.001). The mean ASPECTS was highest in the transient hyperglycemia group (9.45), whereas lower values were found in patients with type 2 diabetes mellitus (8.40) and in the control group (8.50). Low ­ASPECTS (≤ 6 points) was predominantly observed in patients with type 2 diabetes mellitus. Conclusions. Glycemic status does not influence the topography of ischemic lesions but is associated with their vo­lume. Chronic hyperglycemia in type 2 diabetes mellitus is linked to more pronounced early ischemic changes, whereas transient hyperglycemia is characterized by relatively more favorable neuroimaging parameters.