Diabetes mellitus and intracranial stenosis
Correspondencia: Dra. Irene Mendes. Servicio de Neurología. Hospital Garcia de Orta. 2800 Almada, Portugal. Fax: 2727 144.
Introduction: The risk of having a cerebrovascular accident (CVA) is approximately 3 to 5 times greater in the diabetic population than in non-diabetics. The physiopathological mechanisms of CVAs in patients with diabetes mellitus are not well-known, since few studies of this have been done.
Objectives: To verify the hypothesis that intracranial arteriosclerosis, interpreted from findings of stenosis on intracranial Doppler studies, is greater in diabetics than in non-diabetics, independently of other vascular risk factors.
Patients and methods: Patients were selected from the Register of Cerebrovascular Diseases of the Neurology Department of the Hospital de Santa Maria as having had an ischemic cerebrovascular accident (CVA)/transient ischemic accident (TIA), assessed by a colour codified vertebral carotid eco-Doppler and transcranial Doppler. Intracranial changes in the diabetic and non-diabetic groups of patients were compared with relation to the presence of risks such as hypercolestrolaemia, arterial hypertension and smoking.
Results: 384 patients were included, 71 were diabetic and 313 non-diabetic. The two groups were comparable with regard to average age and sex. Intracranial stenosis was approximately 3.13 (95% CI = 1.69-5.79) times more frequent in the diabetic population than in non-diabetics. This difference persisted independently of the presence or absence of other vascular risk factors.
Conclusions: Diabetes mellitus is an important independent risk factor of alterations in the intracranial blood vessels and therefore of CVA. The intracranial circulation should be studied in these patients in view of the great frequency of intracranial stenoses and possible future improvements with therapeutic intervention.
Objetivos Probar la hipótesis de que la frecuencia de arteriosclerosis intracraneal, traducida por signos de estenosis en el Doppler transcraneal, sea significativamente más elevada en los diabéticos, en comparación con los no diabéticos, e independientemente de otros factores de riesgo vascular.
Pacientes y métodos Se seleccionaron los enfermos del Registro de Enfermedades Vasculares Cerebrales del Servicio de Neurología del Hospital de Santa Maria, Lisboa, con accidente cerebrovascular isquémico (ACV)/accidente isquémico transitorio (AIT), evaluados con ecoDoppler carotídea vertebral codificada a color y Doppler transcraneal. Se compararon las alteraciones intracraneales en los grupos de enfermos diabéticos y no diabéticos, en función de la presencia de riesgo tipo hipercolesterolemia, hipertensión arterial y tabaquismo.
Resultados Fueron incluidos 384 enfermos, 71 diabéticos y 313 no diabéticos, siendo los dos grupos comparables en lo que respecta a la edad media y al sexo. Las estenosis intracraneales fueron aproximadamente de 3,13 (95% CI= 1,695,79) veces más frecuentes en la población diabética en comparación con la no diabética. Esta diferencia persiste independientemente de la presencia o no de otros factores de riesgo vascular.
Conclusiones La diabetes mellitus es un importante factor de riesgo independiente para la enfermedad de los vasos intracraneales y consecuentemente para el ACV. Es necesario examinar la circulación intracraneal en estos enfermos, dada la alta frecuencia de estenosis intracraneales y las posibles perspectivas futuras de intervención terapéutica
