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Cardio Diabetes Medicine 2017 153

Stroke in Cardiodiabetic Syndrome:

How different is it?

Dr. K. Mugundhan MD.,DM (Neuro)

Senior Assistant Professor, Dept. of Neurology,
Govt. Mohan Kumaramangalam Medical College Hospital, Salem.Tamilnadu

Introduction ma. Minor sources of cardioembolism are patent fora-
Stroke is the leading cause of disability and the sec- men ovale, atrial septal aneurysm, atrial or ventricular
ond most common cause of death worldwide It septal defects, calcific aortic stenosis, and mitral an-
1,2
is defined as an abrupt onset of focal neurological nular calcification. Although the vast majority of the
deficit that is attributable to a vascular cause. There above causes are already known, the exact mecha-
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are 2 mechanisms by which stroke occurs- Isch- nisms require attention. The dynamics that play an
emic and hemorrhagic. Ischemic strokes are due to important role in cardiac patients that develop stroke
inadequate perfusion of a vascular bed leading to include increased thrombus formation, increased co-
ischemia, tissue necrosis and cell death. Ischemic agulation, reduced fibrinolysis, and increased throm-
stroke can occur due to either 1. Embolism from the bocyte aggregation, endothelial dysfunction. Factors
heart, proximal arteries 2. Thrombosis of large and that increase thrombus formation in cardiac patients
small intra and extracranial arteries and 3. Systemic are due to prevalence of left ventricular hypokinesia,
hypoperfusion. Hemorrhagic strokes usually are due reduced ejection fraction, prevalence of atrial fibril-
to various cause most common being uncontrolled lation and increased blood viscosity. Factors that
hypertension and reperfusion of the previously in- promote coagulation in cardiac disease includes
farcted area. increased D-dimer concentration, increased Throm-
bin-antithrombin complex level, fibrin degradation
Cardio-diabetic syndrome products, thrombin concentration and increased lev-
els of tissue plasminogen activator which activates
The entity of Cardio-diabetic syndrome is relatively the coagulation cascade. It has also been observed
new. The factors that play a vital role in the dynamics that reduced fibrinolysis has been observed in car-
of circulation are entirely different for patients with diac patients due to increased levels of circulating
cardiac disease and patients with diabetic disease. plasminogen activator inhibitor-1. Factors that pro-
Though each one have their own effects in promoting mote thrombocyte aggregation includes raised levels
the nature of progression in stroke, the effects of of P-selectin and β-Thromboglobulin concentration.
cardiac disease and diabetes together has a marked In cardiac disease endothelial dysfunction is due to
role together. But before attributing the combined ef- increased von Willebrand factor concentration, sol-
fects of cardiac disease and diabetes it is essential uble thrombomodulin concentration and E-selectin
to know what really precipitates or promotes stroke level. The prevalence of hypertension and diabetes
in each entity. can both enhance these effects. (Pic 1)
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Mechanism of Stroke in Cardiac disease 4 Mechanism of Stroke in Diabetes Mellitus
The common causes of cardiac conditions precipi- Diabetes causes various microvascular and macro-
tating stroke includes atrial fibrillation, recent myo- vascular changes often culminating in major clinical
cardial infarction, mechanical prosthetic valve, dilated complications, 1 of which, is stroke. Of the several
myocardiopathy, and mitral rheumatic stenosis. Oth- mechanisms implicated in stroke evolution, individ-
er major sources of cardioembolism include infective uals with diabetes are the most vulnerable to the
endocarditis, marantic endocarditis, and atrial myxo- consequences of cerebral small vessel diseases.
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