Aneurysmal Subarachnoid Hemorrhage in a 68-Year-old Hyperglycemic Female Patient: Case Report and Literature Review

Authors

  • Paul Marcel Morgan E-Da Hospital

DOI:

https://doi.org/10.5195/ijms.2019.393

Keywords:

Intracranial Hemorrhages, Diabetes mellitus, hyperglycemia, Traumatic Brain Injury, Intracranial Aneurysm

Abstract

Background: While hyperglycemia is intimately associated with uncontrolled diabetes mellitus (DM), recent clinical studies have demonstrated that hyperglycemia is also present in the early acute phase of stroke and is associated with poor prognosis and increased long-term mortality. About half of patients with acute hemorrhagic stroke also present with hyperglycemia upon admission. But more than 50% of patients with acute hemorrhagic stroke develop hyperglycemia even without a previous history of DM. This sheds new light on the relationship between DM, hyperglycemia, and hemorrhagic stroke, with a pathophysiology that is perhaps more profound than is conventionally understood.

The Case: We report a case of a 68-year-old female, with a history of DM Type 2 and stage 3 hypertension who presents to the emergency room (ER) at the Western Regional Hospital in Belmopan City, Belize, with hemorrhagic stroke and hyperglycemia. Diffuse subarachnoid hemorrhage was found in the frontal, temporal, and parietal regions. Mild intraventricular hemorrhage was also observed in the frontal horns and basal cisterns. And small areas of intraparenchymal hemorrhage were present in the frontal lobes. The patient was stabilized and treated conservatively with calcium channel blockers, and diuretics.

Conclusion: Despite a unifying consensus that is still pending, maintaining glucose levels between 110-120 mg/dl by using continuous insulin infusions after traumatic brain injury or aneurysmal subarachnoid hemorrhage may carry some clinical benefit with slightly improved outcome.

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References

Hesami O, Kasmaei HD, Matini F, Assarzadegan F, Mansouri B, Jabbehdari S. Relationship between intracerebral hemorrhage and diabetes mellitus: a case-control study. J Clin Diagn Res. 2015 Apr;9(4):OC08-10

Chen R, Ovbiagele B, Feng W. Diabetes and Stroke: Epidemiology, Pathophysiology, Pharmaceuticals and Outcomes. Am J Med Sci. 2016 Apr;351(4):380-6.

Hyvärinen M, Tuomilehto J, Mähönen M, Stehouwer Coen DA, Pyörälä K, Zethelius B, et al. Hyperglycemia and Incidence of Ischemic and Hemorrhagic Stroke-Comparison Between Fasting and 2-Hour Glucose Criteria. Stroke. 2009 May;40(5):1633-7.

Simão F, Feener EP. The Effects of the Contact Activation System on Hemorrhage. Front Med (Lausanne). 2017 Jul 31;4:121.

Chalouhi N, Hoh Brian L, Hasan D. Review of Cerebral Aneurysm Formation, Growth, and Rupture. Stroke. 2013 Dec;44(12):3613-22.

Fennell VS, Kalani MYS, Atwal G, Martirosyan NL, Spetzler RF. Biology of Saccular Cerebral Aneurysms: A Review of Current Understanding and Future Directions. Front Surg. 2016 Jul 25;3:43.

Alvis-Miranda H, Alcalá-Cerra G, Moscote-Salazar L. Glycemia in Spontaneous Intracerebral Hemorrhage: Clinical Implications. Romanian Neurosurgery. 2014;21(3):315-26.

Marion DW. Optimum serum glucose levels for patients with severe traumatic brain injury. F1000 Med Rep. 2009; 1: 42.

Myers RB, Lazaridis C, Jermaine CM, Robertson CS, Rusin CG. Predicting Intracranial Pressure and Brain Tissue Oxygen Crises in Patients With Severe Traumatic Brain Injury. Crit Care Med. 2016 Sep;44(9):1754-61.

Boulanger M, Poon MTC, Wild SH, Al-Shahi Salman R. Association between diabetes mellitus and the occurrence and outcome of intracerebral hemorrhage. Neurology. 2016 Aug 30;87(9):870-8.

Yang M, Guo Q, Zhang X, Sun S, Wang Y, Zhao L, et al. Intensive insulin therapy on infection rate, days in NICU, in-hospital mortality and neurological outcome in severe traumatic brain injury patients: A randomized controlled trial. Int J Nurs Stud. 2009 Jun;46(6):753-8.

Chiu C-C, Liao Y-E, Yang L-Y, Wang J-Y, Tweedie D, Karnati HK, et al. Neuroinflammation in animal models of traumatic brain injury. J Neurosci Methods. 2016 Oct 15;272:38-49.

Salim A HP, Dubose J, Brown C, Inaba K, Chan LS, Margulies D. Persistent hyperglycemia in severe traumatic brain injury: an independent predictor of outcome. Am Surg. 2009 Jan;75(1):25-9.

Shi J, Dong B, Mao Y, Guan W, Cao J, Zhu R, et al. Review: Traumatic brain injury and hyperglycemia, a potentially modifiable risk factor. Oncotarget. 2016 Oct 25;7(43):71052-71061

Bosarge PL, Shoultz TH, Griffin RL, Kerby JD. Stress-induced hyperglycemia is associated with higher mortality in severe traumatic brain injury. J Trauma Acute Care Surg. 2015 Aug;79(2):289-94.

Siesjö BK. Basic mechanisms of traumatic brain damage. Annals of Emergency Medicine. Ann Emerg Med. 1993 Jun;22(6):959-69.

Muñoz-Rivas N, Méndez-Bailón M, Hernández-Barrera V, de Miguel-Yanes JM, Jimenez-Garcia R, Esteban-Hernández J, et al. Type 2 Diabetes and Hemorrhagic Stroke: A Population-Based Study in Spain from 2003 to 2012. J Stroke Cerebrovasc Dis. 2016 Jun;25(6):1431-43.

Owolabi L, Nagode M, Ibrahim A, Uloko A, Gezawa I, Datti M. Stroke in patients with diabetes mellitus: a study from North Western Nigeria. Afr Health Sci. 2016 Sep;16(3):781-789.

Hernando A-M, Gabriel A-C, Luis Rafael M-S. Glycemia in Spontaneous Intracerebral Hemorrhage: Clinical Implications. Romanian Neurosurgery. 2014; 21(3): 315-26.

Simão F, Ustunkaya T, Clermont AC, Feener EP. Plasma kallikrein mediates brain hemorrhage and edema caused by tissue plasminogen activator therapy in mice after stroke. Blood. 2017 Apr 20;129(16):2280-2290.

Paul M. Morgan MM, Velabo Mdluli. Fragment-Based Design of a Potential TNF-α Inhibitor Inspired by Castanospermine and Methyl Phenylacetate. E-Da Medical Journal. 2018; 5(3): 9-18.

Paul Morgan MM, Chih-Wen Lin. In silico Study of 1,687 FDA Approved Drugs and 612 Natural Products Reveals Benzydamine’s Potential as a Direct Inhibitor of TNF-α. IRJPMS. 2018; 2(2): 13-8.

Meier R, Béchir M, Ludwig S, Sommerfeld J, Keel M, Steiger P, et al. Differential temporal profile of lowered blood glucose levels (3.5 to 6.5 mmol/l versus 5 to 8 mmol/l) in patients with severe traumatic brain injury. Crit Care. 2008;12(4):R98.

Published

2019-08-31

How to Cite

Morgan, P. M. (2019). Aneurysmal Subarachnoid Hemorrhage in a 68-Year-old Hyperglycemic Female Patient: Case Report and Literature Review. International Journal of Medical Students, 7(2), 45–49. https://doi.org/10.5195/ijms.2019.393