Neurological Deficit and Cerebral Hemodynamic Characteristics in Patients with Carotid Territory Ischemic Stroke According to the Presence of Type 2 Diabetes Mellitus

Abstract

Background: Type 2 diabetes mellitus is one of the most important metabolic risk factors associated with ischemic stroke. Chronic hyperglycemia contributes to endothelial dysfunction, vascular stiffness, microvascular injury, and impaired cerebral autoregulation. These mechanisms may worsen cerebral perfusion and increase the severity of neurological deficit during acute ischemic stroke. Recent evidence also indicates that diabetes mellitus may be associated with impaired cerebral autoregulation in ischemic stroke patients.

Objective: To evaluate the association between type 2 diabetes mellitus, neurological status, cerebral blood flow parameters, and vascular reactivity in patients with first-ever carotid territory ischemic stroke.

Methods: This prospective observational study included patients admitted with first-ever acute carotid territory ischemic stroke. Patients were divided according to the presence or absence of type 2 diabetes mellitus. Neurological severity was assessed using the National Institutes of Health Stroke Scale, the modified Rankin Scale, and the Rivermead Mobility Index. Cerebral hemodynamics were evaluated by duplex ultrasonography of the brachiocephalic arteries with functional compression testing. The analysis focused on neurological deficit, cerebral blood flow velocity, vascular reactivity, arterial elasticity, and recovery after compression.

Results: Patients with type 2 diabetes mellitus demonstrated more pronounced neurological impairment and poorer functional mobility compared with non-diabetic patients. Diabetic patients also showed signs of impaired cerebral hemodynamics, including reduced vascular reactivity, delayed recovery after compression, increased peripheral vascular resistance, and reduced arterial elasticity. These findings suggest that diabetes-related vascular injury may limit cerebrovascular reserve during acute ischemic stroke.

Conclusion: Type 2 diabetes mellitus is associated with more severe neurological deficit and impaired cerebral hemodynamic regulation in patients with carotid territory ischemic stroke. Assessment of cerebral blood flow and vascular reactivity in diabetic patients may improve early prognostic evaluation and support individualized secondary prevention strategies.