Mechanism of cerebral edema in children with diabetic ketoacidosis

Nicole S. Glaser, Sandra L. Wootton-Gorges, James P. Marcin, Michael H Buonocore, Joseph Dicarlo, E. Kirk Neely, Patrick Barnes, Jenny Bottomly, Nathan Kuppermann

Research output: Contribution to journalArticle

166 Scopus citations

Abstract

Objectives Cerebral edema during diabetic ketoacidosis (DKA) has been attributed to osmotic cellular swelling during treatment. We evaluated cerebral water distribution and cerebral perfusion during DKA treatment in children. Study design We imaged 14 children during DKA treatment and after recovery, using both diffusion and perfusion weighted magnetic resonance imaging (MRI). We assessed the apparent diffusion coefficients (ADCs) and measures reflecting cerebral perfusion. Results The ADC was significantly elevated during DKA treatment (indicating increased water diffusion) in all regions except the occipital gray matter. Mean reductions in the ADC from initial to postrecovery MRI were: basal ganglia 4.7 ± 2.5 × 10 -5 mm 2/s (P=.002), thalamus 3.7 ± 2.8 × 10 -5 mm 2/s, (P=.002), periaqueductal gray matter 4.3 ± 5.1 × 10 -5 mm 2/s (P=.03), and frontal white matter 2.0 ± 3.1 × 10 -5 mm 2/s (P=.03). In contrast, the ADC in the occipital gray matter increased significantly from the initial to postrecovery MRI (mean increase 3.9 ± 3.9 × 10 -5 mm 2/s, P=.004). Perfusion MRI during DKA treatment revealed significantly shorter mean transit times (MTTs) and higher peak tracer concentrations, possibly indicating increased cerebral blood flow (CBF). Conclusions Elevated ADC values during DKA treatment suggests a vasogenic process as the predominant mechanism of edema formation rather than osmotic cellular swelling.

Original languageEnglish (US)
Pages (from-to)164-171
Number of pages8
JournalJournal of Pediatrics
Volume145
Issue number2
DOIs
StatePublished - Aug 2004

Keywords

  • ADC
  • Apparent diffusion coefficient
  • CBF
  • CBV
  • Cerebral blood flow
  • Cerebral blood volume
  • Diabetic ketoacidosis
  • DKA
  • Echo planar imaging
  • EPI
  • Gadolinium-DTPA
  • GCS
  • Gd
  • Glasgow Coma Scale
  • Magnetic resonance imaging
  • Mean transit time
  • MRI
  • MTT
  • Time to peak
  • TTP

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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