Stress hyperglycemia (SH) is a common phenomenon that is present in about 50% of patients with acute ischemic stroke (AIS). It is thought to be a main risk factor for poor functional outcome among patients with AIS undergoing intravenous thrombolysis (IVT).

To investigate the predictive value of glycemic indicators for early neurological outcomes (ENOs) in patients with AIS treated with IVT.

We retrospectively reviewed a prospectively collected database of patients with AIS who underwent IVT at the Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, between January 2017 and June 2022. ENO included early neurological improvement (ENI) and early neurological deterioration (END), defined as a decrease or increase in the National Institutes of Health Stroke Scale (NIHSS) score between baseline and 24 hours after IVT. We analyzed the associations between glycemic indicators [including admission hyperglycemia (AH), fasting blood glucose (FBG), and SH ratio (SHR)] and ENO in all patients and in subgroups stratified by diabetes mellitus (DM).

A total of 819 patients with AIS treated with IVT were included. Among these, AH was observed in 329 patients (40.2%). Compared with patients without AH, those with AH were more likely to have a higher prevalence of DM (P < 0.001) and hypertension (P = 0.031) and presented with higher admission NIHSS scores (P < 0.001). During the first 24 hours after IVT, END occurred in 208 patients (25.4%) and ENI occurred in 156 patients (19.0%). Multivariate mixed logistic regression analyses indicated that END was independently associated with AH [odds ratio (OR): 1.744, 95% confidence interval (CI): 1.236-2.463; P = 0.002]. Subjects were classified into four groups representing quartiles. Compared with Q1, patients in the higher quartiles of SHR (Q2: OR: 2.306, 95%CI: 1.342-3.960; P = 0.002) (Q3: OR: 2.284, 95%CI: 1.346-3.876; P = 0.002) (Q4: OR: 3.486, 95%CI: 2.088-5.820; P = 0.001) and FBG (Q3: OR: 1.746, 95%CI: 1.045-2.917; P = 0.033) (Q4: OR: 2.436, 95%CI: 1.476-4.022; P = 0.001) had a significantly higher risk of END in the overall population. However, none of the glycemic indicators were found to be associated with ENI in patients with or without DM.

Our study demonstrated that glycemic indicators in patients with stroke treated with IVT were associated with the presence of END rather than ENI during the first 24 hours after admission.

The management of blood pressure variability (BPV) in acute stroke presents a complex challenge with profound implications for patient outcomes. This narrative review examines the role of BPV across various stages of acute stroke care, highlighting its impact on treatment strategies and prognostic considerations. In the prehospital setting, while guidelines lack specific recommendations for BP management, emerging evidence suggests a potential link between BPV and outcomes. Among ischaemic stroke patients who are ineligible for reperfusion therapies, BPV independently influences functional outcomes, emphasising the need for individualised approaches to BP control. During intravenous thrombolysis and endovascular therapy, the intricate interplay between BP levels, recanalisation status, and BPV is evident. Striking a balance between aggressive BP lowering and avoiding hypoperfusion-related complications is essential. Intracerebral haemorrhage management is further complicated by BPV, which emerges as a predictor of mortality and disability, necessitating nuanced BP management strategies. Finally, among patients with acute subarachnoid haemorrhage, increased BPV may be correlated with a rebleeding risk and worse outcomes, emphasizing the need for BPV monitoring in this population. Integration of BPV assessment into clinical practice and research protocols is crucial for refining treatment strategies that are tailored to individual patient needs. Future studies should explore novel interventions targeting BPV modulation to optimise stroke care outcomes.

Blood pressure (BP) excursion on admission was common in patients with acute ischemic stroke, but its influence on thrombolysis effect was not fully evaluated.

Patients with acute ischemic stroke who received thrombolysis without subsequent thrombectomy were included. Admission BP excursion was defined as higher than 185/110 mmHg. Multivariate logistic regression analysis was used to evaluate the relationship between admission BP excursion and poor outcome as well as hemorrhage rates and mortality. Poor outcome was defined as a 90-day modified Rankin Scale score 3-6. Subgroup analysis was performed according to stroke severity, which was assessed by the National Institutes of Health Stroke Scale (NIHSS) score, and hypertension status.

A total of 633 patients were enrolled and 240 participants (37.9%) had admission BP excursion. Admission BP excursion was associated with poor outcome [adjusted odds ratio (OR) 0.64, 95% confidence interval 0.42-0.99, P  = 0.046]. No significant difference was found regarding hemorrhage rates or mortality between patients with and without admission BP excursion. In subgroup analysis, admission BP excursion was related to poor outcome in patients with NIHSS score at least 7 (adjusted OR 1.89, 95% confidence interval 1.03-3.45, P  = 0.038), but not in patients with NIHSS score less than 7 ( P for interaction <0.001).

Admission BP excursion above the guideline thresholds did not increase postthrombolysis hemorrhage risk or mortality, but was associated with poor outcome, especially in patients with severe stroke.