الفهرس 
ANATOMY AND BLOOD SUPPLY OF THE BRAINOnly 14 pages are availabe for public view
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Abstract
troke is defined as brain dysfunction symptoms lasting
more than ٢٤ hours or imaging of an acute clinically
relevant brain lesion in patient with rapidly vanishing symptoms
lasting less than ٢٤ hours but with infarction imaged by MRI
have been reclassified as having stroke instead of transient
ischemic attack.
Hyperglycemia is encountered in ٢٠٪ to ٤٠ % of acute
stroke patients,with or without a pre-morbid diagnosis of
diabetes mellitus. Hyerglycemia is a risk factor for infarct
expansion and poor outcome through the first ٧٢ hours of
hospitalization in both diabetics and non- diabetics.
Stress hyperglycemia is defined as a transient plasma
glucose level above ٢٠٠ mg/dl and it is thought to be caused by
the increased levels of cortisol, glucagon and epinephrine,theses
hormones increase gluconeogenesis and decrease peripheral
uptake of glucose to ensure substrate availability. This is also
due to use of glucocorticoid therapy and continuous nutrition.
Hyperglycemia is of interest as it is associated with poor
outcomes from acute hospital admission for other conditions.
Major and minor studies of stroke patients suggested that
”stress hyperglycemia” (raised blood glucose levels without a previous diagnosis of diabetes) was associated with a poorer
outcome.
Stress hyperglycemia had the worst short-term outcome
compared with diabetic group and control group (٨٥٫٧٪ vs.
٤٥٪ vs. ٥٪; respectively). It was found that Patients with
hyperglycemia had higher incidence of intracerebral
complications, namely hemorrhagic transformation (١٧٫٧٪)
and brain oedema (٩٫٦٧٪).
A meta-analysis suggests that the relative risk of death in
hyperglycemic non-diabetic stroke patients is increased by ٣٫٣٪,
recent analysis of both prospective and case control studies have
confirmed the importance of acute hyperglycemia as a predictor
of outcome after stroke.
Scales that measure neurological deficits or specific body
functions can be used especially well for triage and to guide
acute treatment decisions. The NIHSS,for example, is a valuable
tool for initial assessments of patients with stroke in emergency
departments,hospitals, or in the pre-hospital setting, and the
confidence of the patient and family can be greatly enhanced by
the ability to offer an accurate prognosis. A reliable prognosis
allows better planning for supportive care, more accurate
information to be given to relatives and resources to be allocated
in a more efficient way.