Blood–Brain Barrier Disruption, Vascular Impairment, and Ischemia/Reperfusion Damage in Diabetic Stroke

troke is a major cause of death and long-term disability accompanied by steep social and medical costs.Diabetes mellitus (DM) is a chronic, lifelong, severe metabolic health problem characterized by hyperglycemia, attributable to insulin deficiency, insulin resistance, or a combination of both.Patients with DM suffer from massive vascular damage and rapidly develop microvascular and macrovascular diseases, often leading to end organ damage such as damage to the kidneys, eyes, and peripheral nervous system. 1 DM raises the risk of cardiovascular and cerebrovascular diseases (such as ischemic stroke) multifolds. 2 Approximately 30% of stroke patients have DM, 2 and stroke in diabetic patients follows a specific clinical pattern mostly resulting in poor prognosis. 3,4DM alters metabolism, and complicates stroke pathology, making it challenging to treat the diabetic ischemic brain.Long-term functional recovery in patients with DM-stroke is often hindered by increased predisposition to recurrent strokes. 5As a result, neurological deficits and fatality rates are significantly higher in patients with stroke who also have DM. 68][9] In this article, we review diabetic stroke-induced blood-brain barrier (BBB) disruption, vascular and reperfusion damage, as well as underlying pathophysiological mechanisms such as shear stress, diminished fibrinolytic capacity, mitochondrial dysfunction, and oxidative stress as well as neuroinflammation in mediating diabetic stroke-induced vascular and reperfusion damage.