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There were no significant differences in age or sex among the three groups and control patients.Insulin levels were significantly higher in the lacunar group compared with the subcortical arteriosclerotic encephalopathy group,the macroangiopathy group,and the control patients (median[interquartile range]:103.8[198.6],72.0[103.2],66.0[57.0],and 52.2[ 57.0]pmol/L,respectively;all P<.05,Mann-Whitney test).There was a statistically significant difference in insulin concentrations between the microangiopathy group(subcortical arteriosclerotic encephalopathy and lacunes)and the macroangiopathy and control groups(81.0[110.4],66.0[57.0], and 55.2[57.0]pmol/L,respectively;all P<.05 Mann-Whitney).The same was true for the distribution of C-peptide levels and to a minor extent blood glucose values,but these differences failed to reach statistical significance.Elevated insulin levels potentially represent a pathogenetic factor in the development of cerebral small-vessel disease,predominantly in patients presenting with lacunes.Whether this is due solely to atherosclerotic changes of the small penetrating arteries or whether changes in hemorheology are operative as well remains to be evaluated. |
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cerebrovascular accident
cerebrovascular accident,pathophysiology
hyperinsulinism
lacunar infarction
lacunar infarction,pathogenesis of
microangiopathy,brain
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