An Autopsy Study of Cerebrovascular Accident in Diabetes Mellitus

A two-part study has been presented dealing with a comparison of cerebrovascular accident (CVA) as between diabetic and nondiabetic subjects. In the first part it has been shown that the frequency of CVA is increased in diabetes. While cerebral hemorrhage occurs slightly more commonly in the nondiabetic group, cerebral infarction and focal encephalomalacia occur about 1.5 times more frequently in the diabetic group. In the second part a comparison has been made of the frequency of hemodynamic, inflammatory, atheromatous, thrombotic, and proliferative vascular disease between 75 cases of diabetes and 77 nondiabetic subjects. It has been shown that hemodynamic disease of small intraparenchymal cerebral vessels occurs more frequently in the diabetic group, but the increase is of essentially the same order of magnitude as the increase in the frequency of hypertension in diabetes. No significant difference between the two groups was found as regards the frequency of inflammatory, atheromatous, or thrombotic vascular disease. Proliferative lesions of small intraparenchymal cerebral vessels were present about 2.5 times more often in diabetes. The possible role of such lesions in accounting for the increase in the frequency of focal areas of encephalomalacia and in enhancing infarct formation when there is impairment of circulation in the larger cerebral arteries has been pointed out. A hypothesis, with some suggestive supporting evidence indicating that these proliferative lesions may be immunogenic in origin, has been discussed.