Abstract: Objective To investigate the relationship between acute insular infarction and stress hyperglycemia (SH) in the elderly. Methods A total of 75 patients (≥60 years) with acute anterior circulation ischemic stroke (ACI) in the Emergency Department of Jiangsu Province Hospital from January 2017 to December 2018 were enrolled. According to MRI, the patients were divided into insular cortex involved group and non-involved group. The clinical features were collected, as well as National Institute of Health Stroke Scale (NIHSS), blood pressure, serum glucose, hemoglobin, creatinine and glycosylated hemoglobin (HbA1c). Stress hyperglycemia ratio (SHR) was used to assess the intensity of SH. SHR was classified by quartile category. Ordinal regression analysis was used to explore the relationships between the risk factors and the increase of SHR category.SHR≥1.14 was defined as SH, and then binary Logistic regression analysis was performed to predict the risk of post-stroke SH. Results There were significant differences in diabetes mellitus history (P=0.027) and SH (P =0.041) between the insular cortex involved group and non-involved group. With the increase of NIHSS score, SHR showed an upward trend(r²=0.121). The risk of the increase of SHR category increased to 1.214-fold (P=0.017) with the increase of 1 point of NIHSS score, and to 2.641-fold (P=0.036) with insular involvement. The risk of SH increased to 2.917-fold (P=0.041) with insular involvement. Conclusions Insular involvement is an independent risk factor for SH in the elderly patients with ACI.

Key words: aged, acute anterior circulation cerebral infarction, stress hyperglycemia, insular infarction