Does admission hyperglycemia predict intracranial and extracranial vasculopathy?

Objective: To study the association between admission hyperglycaemia and the presence and pattern of intracranial and extracranial vascular disease. Methods: This retrospective study was conducted at a major tertiary care hospital in Karachi, Pakistan. Patients who had presented with acute stroke and had undergone a carotid ultrasound doppler of the carotids and/or Magnetic Resonance Angiography (MRA) of the brain were included in the study. A multiple logistic regression analysis of variables was done for an abnormal finding on each investigation. Results: Out of the total of 216 patients, the age of majority of the patients (83.3%) was >50 years and 134 (62%) were male. One hundred and fourteen patients (52.8%) had admission hyperglyaemia. Multiple logistic regression analysis revealed that increasing age and admission hyperglycaemia (P=0.045, Odds ratio=1.9 [95% CI: 1.0-3.6]) were independent predictors of an abnormal finding on a carotid doppler investigation. Admission hyperglycaemia did not predict the presence of general intracranial vasculopathy but it was significantly associated with focal stenosis as visualized on a MRA. Conclusion: Admission hyperglycaemia is associated with large vessel disease manifesting itself in the carotids as plaques and in the intracranial circulation as focal stenosis. Acute stroke patients presenting with admission hyperglycemia would require a more careful investigation for large artery disease especially in the extracranial vessels.