Cerebrovascular Disease

Diabetes is a strong risk factor for ischemic stroke, and stroke in diabetes is both more severe in presentation and outcome and more recalcitrant to acute treatment. Although many etiologies of stroke are made more common by diabetes, the most common type of stroke found in persons with diabetes is lacunar microvascular infarction. Prevention of stroke in individuals with diabetes is best served through aggressive management of concurrent hypertension and hyperlipidemia. Careful glycemic control also likely reduces the risk of stroke, but the risk reduction is not nearly as robust. Antiplatelet therapy also plays an important role; a single antithrombotic agent is sufficient for the prevention of ischemic stroke. Hyperglycemia in the acute phase after ischemic stroke is associated with poor outcomes, and aggressive management likely improves functional recovery.