Relation to Diabetes

Diabetes mellitus is associated with an increased risk for atherosclerotic vascular disease including cerebrovascular disease. This increased risk is probably related both to direct adverse effects of hyperglycemia and the associated clustering of risk factors such as hypertension, dyslipidemia and a procoagulant state in patients with diabetes mellitus. The morbidity and mortality from atherosclerotic disease appears to be greater in diabetic patients when compared to their non-diabetic counterparts. Not only is the risk for stroke increased for patients with diabetes mellitus, but the risk for adverse outcomes from stroke is also increased. Information about approaches to risk reduction and management of stroke in diabetic patients must often be inferred from studies in non-diabetic patients. However, a number of important studies of risk reduction have included sufficient numbers of diabetic patients to be able to draw direct conclusions in diabetic patients.
This chapter will review the observations of diabetes and other variables that increase the risk for stroke (with emphasis on ischemic strokes). The chapter will also summarize the effects of interventions for prevention of stroke and management of acute stroke. The role for surgical intervention will be briefly summarized.