Assessment of severity of stroke by NIHSS in comparison with infarct size in stroke

Abstract

Stroke is the second leading causes of death worldwide and one of the leading causes of disability. The most common cause of stroke is represented by cerebral ischemia and approximately 80% of strokes are due to ischemic cerebral infarction and 20% due to brain haemorrhage. Diabetes Mellitus is a very common metabolic disorder and it is an independent risk factor for stroke and is associated with 2 to 6 fold increased risk compared with non-diabetic subjects and worsens survival of patients with acute stroke. Glucose intolerance or even fasting hyperglycemia may follow an acute vascular event, and ensuing physical inactivity and poor food intake may lead to continued glucose intolerance. Thus, glucose intolerance in a stroke patient may or may not reflect glycemia prior to the event. Measurement of HbA1C rather than glucose as an indicator of prior glycemia offers a new perspective. The rate of non-enzymic glycosylation of hemoglobin is believed to depend largely or solely on plasma glucose concentration. Hence this study is to correlate HbA1c levels with clinical profile and Infarct size in patients with Acute Ischemic stroke.To see the levels of HbA1c in Acute Ischemic stroke patients. To calculate the infarct size and severity of stroke in Acute Ischemic stroke patients. To estimate the HbA1C levels and correlate HbA1C levels with clinical profile and size of infarct in Acute ischemic stroke patients. This a cross sectional descriptive study. This is an cross sectional study including 64 patients. Maximum number of patients were in the age group of 60 – 69 years, with mean age of 63.59±12.59 years. The male to female of 1.37 : 1. There were 25 patients (39.1%) well controlled Diabetes patients,16(25.0%) fairly controlled and 23 (35.9%)were poorly controlled Diabetic patient. The common risk factors were Diabetes mellitus, hypertension, smoking, dyslipidemia, Rheumatic heart disease and Retroviral disease. The NIHSS score increased as the infarct size increased from well controlled to poorly controlled diabetes.Increased severity of stroke is seen in poorly controlled diabetes which correlates with the infarct size. HbA1c levels, NIHSS score correlates well with the infarct size.Patients with poorly controlled diabetes were found to have increased NIHSS score and increased severity of stroke. Severity of the stroke worsened from well controlled diabetes to poorly controlled diabetes. HbA1c should be considered as an independent risk factor for poor clinical outcome and worse prognosis. Early diagnosis and treatment of diabetes including lifestyle modification and periodic monitoring of HbA1c levels may reduce the development of stroke and morbidity and mortality associated with it.