Occurrence of diabetes mellitus in spontaneous intracerebral hemorrhage

Spontaneous Simultaneous Bilateral Basal Ganglia, Thalamic, and Central Pontine Haemorrhage: A Case Report

The basal ganglia, a complex of subcortical nuclei, form an important functional component of the brain. Spontaneous simultaneous bilateral basal ganglia haemorrhage (SSBBGH) is exceedingly uncommon and often associated with hypertension as a primary predisposing factor. We report a case of a 72-year-old female who presented to a local hospital following a dizzy spell and subsequent fall. Non-contrast CT brain revealed bilateral basal ganglia haemorrhage alongside central pontine haemorrhage. Subsequently, she was transferred to our tertiary-care specialist stroke unit where conservative management was pursued. She was discharged after brain imaging, multidisciplinary team (MDT) consultations, and follow-up plans. The MDT comprised stroke physicians, radiologists, physiotherapists, occupational therapists, and speech and language therapists. Given the limited number of documented cases of this rare occurrence (approximately 60 in the literature), we believe this report will contribute to the existing body of knowledge.

Association of Diabetes and Glycated Hemoglobin With the Risk of Intracerebral Hemorrhage: A Population-Based Cohort Study

OBJECTIVE

To examine the association of diabetes and glycated hemoglobin (HbA_1c) with the risk of intracerebral hemorrhage (ICH) in a large population-based cohort.

RESEARCH DESIGN AND METHODS

The computerized database of the largest health care provider in Israel was used to identify adult members aged 40 years or older and alive at 1 January 2010 (297,486 with diabetes and 1,167,585 without diabetes). The cohort was followed until 31 December 2017 for incidence of ICH. Multivariable Cox proportional hazards regression models, adjusted for baseline disease risk score, were applied to estimate the hazard ratio (HR) of ICH.

RESULTS

Overall 4,170 ICH cases occurred during 10,730,915 person-years of follow-up. Diabetes was independently associated with increased ICH risk, with hazard ratio (HR) 1.36 (95% CI 1.27-1.45), and increased with longer diabetes duration: 1.23 (1.12-1.35) and 1.44 (1.34-1.56) for diabetes duration ≤5 years and >5 years, respectively. The increased ICH risk associated with diabetes was more pronounced in patients ≤60 years old (P _interaction <0.001). Among patients with diabetes, HbA_1c had a nonlinear J-shaped relationship with ICH (P for nonlinearity = 0.0186). Compared to the fourth HbA_1c decile, 6.5-6.7% (48-50 mmol/mol), the HR for ICH was 1.27 (1.01-1.59) and 2.19 (1.75-2.73) in the lowest HbA_1c decile, ≤6.0% (≤42 mmol/mol), and highest HbA_1c decile, >9.3% (>78 mmol/mol), respectively.

CONCLUSIONS

Diabetes is associated with increased risk of ICH that is directly associated with diabetes duration. ICH and HbA_1c appear to have a J-shaped relationship, suggesting that both poor control as well as extreme intensive diabetes control might be associated with increased risk.

Relationship between intracerebral hemorrhage and diabetes mellitus: a case-control study

INTRODUCTION

The role of diabetes mellitus in the pathogenesis of intracerebral hemorrhage (ICH) is controversial. Underlying comorbidities such as diabetes mellitus may increase the risk of intracerebral hemorrhage. In this study, we sought to assess the role of diabetes mellitus in the occurrence of intracerebral hemorrhage.

MATERIALS AND METHODS

In this case-control study, the prevalence of diabetes mellitus was evaluated in 120 patients presenting with intracerebral hemorrhage and in a control group of 135 patients with low back pain. All patients were treated at the Departments of Neurology and Neurosurgery, Shohadaye Tajrish University Hospital, Tehran, Iran between 2008 and 2012. T-test was applied for analysing the quantitative variables and chi-square and Fisher's exact tests were used to analyse qualitative variables.

RESULTS

The mean age was 67.5±12.7 y in patients with intracerebral hemorrhage and 70.5±12.6 y in the control group (p=0.201). Diabetes mellitus was found in 39 patients with intracerebral hemorrhage (33.1%) and 30 (22.2%) control subjects (p=0.054). The prevalence of diabetes mellitus in patients younger than 60 y was 7.4% in the control group and 27.8% in the case group (p=0.042).

CONCLUSION

In our study, no significant relationship was found between diabetes mellitus and intracerebral hemorrhage (except in patients younger than 60 years) and diabetes mellitus did not cause bleeding in certain brain areas. However, more studies are required on the correlation of diabetes mellitus and intracerebral hemorrhage in the same population to reach a definite conclusion.