Published online November 26, 2007
PEDIATRICS Vol. 120 No. 6 December 2007, pp. e1540-e1546 (doi:10.1542/peds.2007-0366)
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EXPERIENCE & REASON

Coma With Diffuse White Matter Hemorrhages in Juvenile Diabetic Ketoacidosis

Farid H. Mahmud, MDa, David A. Ramsay, MB, ChBb, Simon D. Levin, MDc, Ram N. Singh, MBBSd, Trevor Kotylak, MDe and Douglas D. Fraser, MD, PhDd

a Division of Pediatric Endocrinology
b Department of Pathology, Divisions of
c Pediatric Neurology
d Pediatric Critical Care Medicine
e Department of Radiology, Children's Hospital of Western Ontario, London, Ontario, Canada

ABSTRACT

Cerebral edema is the most common neurologic complication of diabetic ketoacidosis in children. A minority of young patients with intracerebral crises in diabetic ketoacidosis present with cerebrovascular accidents. We report 2 adolescent patients with diabetic ketoacidosis who presented with coma and diffuse white matter hemorrhages in the absence of either cerebral edema or cerebrovascular accidents. These 2 cases illustrate a novel clinical and neuropathologic description of diffuse white matter hemorrhages, possibly related to a cytotoxic process as the underlying mechanism. These case descriptions emphasize that pediatric patients with diabetic ketoacidosis and coma can present with pathology not related to either cerebral edema or cerebrovascular accidents.

Key Words: diabetes • DKA • hemorrhage • white matter changes

Abbreviations: CE, cerebral edema • DKA, diabetic ketoacidosis • SIR, systemic inflammatory response • GCS, Glasgow Coma Scale • CT, computed tomography; MRI, magnetic resonance imaging

Accepted May 17, 2007.


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