Cerebrovascular complications of diabetes: focus on stroke

Abstract

Cerebrovascular complications make diabetic patients 2-6 times more susceptible to a stroke event and this risk is magnified in younger individuals and in patients with hypertension and complications in other vascular beds. In addition, when patients with diabetes and hyperglycemia experience an acute ischemic stroke they are more likely to die or be severely disabled and less likely to benefit from the one FDA-approved therapy, intravenous tissue plasminogen activator. Experimental stroke models have revealed that chronic hyperglycemia leads to deficits in cerebrovascular structure and function that may explain some of the clinical observations. Increased edema, neovascularization and protease expression as well as altered vascular reactivity and tone may be involved and point to potential therapeutic targets. Further study is needed to fully understand this complex disease state and the breadth of its manifestation in the cerebrovasculature.

Fig. 1. Cerebral Complications of Diabetes

Hyperglycemia leads to microvascular dysfunction, triggering both neuronal/glial and vascular injury pathways. While pathologic neurovascular remodeling increases the risk of bleeding after ischemic stroke and reperfusion, cell damage to neurons and glial cells also play a part in blood brain barrier disruption and cognitive impairment