Stroke in patients with diabetes mellitus: a study from North Western Nigeria.

Lukman Owolabi, Mansur Nagode, Aliyu Ibrahim, Andrew Uloko, Ibrahim Gezawa, Mohammad Datti
1. Aminu Kano Teaching Hospital, Bayero University.
2. Murtala Muhammad Specialist Hospital, Department of Medicine.

Abstract
Background: Stroke is one of the major causes of morbidity and mortality worldwide and apart from being exceedingly harmful in diabetics, stroke is a disabling disorder. The study was undertaken to describe the clinical characteristics, outcome pattern  and predictors of mortality in a cohort of diabetic patients presenting with stroke in two tertiary health facilities in North Western Nigeria.

Method: Out of all stroke patients seen from June 2007 to February 2011, persons with diabetes mellitus presenting with stroke  in the emergency unit of the two tertiary hospitals in Kano were consecutively recruited for the study. Classification of stroke  into hemorrhagic and infarctive subtypes was based on brain computerized tomography (CT), brain magnetic resonance imaging  (MRI) and World Health Organization (WHO) criteria. Follow-up period was for thirty days.

Result:Out of the five hundred and thirty six stroke patients seen during the study period, 85 (15.9%) patients, comprising 48  (56.5%) males, had diabetes. Thirty eight (44.7%) of the identified diabetics were previously undiagnosed. Sixty four (75.3%)  had infarctive stroke. One-month case fatality rate was 30.6%. Factors associated with death included male sex, past history of  TIA, abnormal respiratory pattern, hemorrhagic stroke, aspiration pneumonitis, and worsening GCS. Aspiration pneumonitis  and worsening GCS were independent predictors of one month mortality of stroke in the patients.

Conclusion: In DM patients studied, infarctive stroke was more common, case fatality was 30.6%. Male gender, past history  of TIA, abnormal respiratory pattern, hemorrhagic stroke, aspiration pneumonitis, and worsening Glasgow Coma Score (GCS)  were associated with mortality. Aspiration pneumonitis and worsening GCS were independent predictors of one month mortality of stroke in diabetic patients.

Keywords: Stroke, diabetes, stroke, Nigeria