The glucose paradox of cerebral ischemia, the aggravation of delayed neuronal damage by preischemic hyperglycemia, is a well‐documented phenomenon. Recently, we demonstrated that corticosterone (CT) plasma levels were significantly elevated within 30 min after glucose administration (i.p.) only to return to baseline levels by 120 min. In this study we examined the postulate that preischemic glucose loading aggravates the postischemic outcome via the induction of a short‐lived, massive elevation in CT plasma levels. Hence, we tested the ability of the CT synthesis inhibitor metyrapone (MT) and the glucocorticoid receptor antagonist, mifepristone (RU486), to attenuate the aggravated delayed neuronal damage in a rat model of cardiac‐arrest‐induced transient global cerebral ischemia (TGI). Seven different groups of 24‐h‐fasted rats were used and were administered several treatments prior to TGI that were aimed at either inhibiting CT synthesis (MT, 100 mg/kg, i.p.) or at blocking the brain glucocorticoid receptors (RU486, 40 mg/kg, i.p.). Plasma glucose and CT levels were measured 2 min pre‐TGI. Neuronal damage was assessed 7 days post‐TGI in hippocampal slices using electrophysiological means. Plasma glucose levels were not reduced in MT‐ or RU486‐treated rats. Both MT and RU 486 prevented preischemic hyperglycemia‐aggravated ischemic damage, the former presumably via inhibition of CT synthesis, the latter by glucocorticoid receptor antagonism. The present data strongly suggest that preischemic hyperglycemia‐aggravated neuronal damage, i.e. the glucose paradox, results from glucose‐induced CT release, rather than intensification of lactic acidosis in the ischemic brain.
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