Cerebrovascular Accident Complicating Diabetic Ketoacidosis in a Nigerian Adolescent: A Case Report and Review of the Literature
DOI:
https://doi.org/10.30442/ahr.0704-09-151Keywords:
Cerebral Oedema, Cerebrovascular Disease, Hemiplegia, Hyperglycaemia, Stroke, Type 1 Diabetes mellitusAbstract
Cerebrovascular accident (CVA) is a rare neurological complication of diabetic ketoacidosis (DKA) in the paediatric population. The risk of developing CVA in DKA patients is often increased due to abnormalities in coagulation factors, platelet activation, blood volume and flow, and vascular reactivity. Cerebral oedema, the most common neurological complication of DKA, may also predispose to CVA. We report the case of a -12-year-old adolescent with DKA complicated by CVA. She developed features of right hemispheric CVA while on admission and had radiological confirmation of an ischaemic CVA. This report highlights that cerebrovascular accidents in DKA can easily be missed or confused with cerebral oedema.
References
Curtis JR, To T, Muirhead S, Cummings E, Daneman D. Recent trends in hospitalization for diabetic ketoacidosis in Ontario children. Diabetes Care 2002; 25: 1591-1596. https://doi.org/10.2337/diacare.25.9.1591
Edge JA, Ford-Adams ME, Dunger DB. Causes of death in children with insulin-dependent diabetes 1990–96. Arch Dis Child 1999; 81: 318-323. https://doi.org/10.1136/adc.81.4.318
Otieno CF, Kayima JK, Omonge EO, Oyoo GO. Diabetic ketoacidosis: risk factors, mechanisms and management strategies in sub-Saharan Africa: a review. East Afr Med J 2005; 82: 197-203. https://doi.org/10.4314/eamj.v82i12.9382
Azad C, Kaur R, Singh DK, Arya A. Stroke in Pediatric diabetic ketoacidosis: Case series. J Trop Pediatr 2017; 63: 324-327. https://doi.org/10.1093/tropej/fmw088
Ahuja W, Kumar N, Kumar S, Rizwan A. Precipitating risk factors, clinical presentation, and outcome of diabetic ketoacidosis in patients with type 1 diabetes. Cureus 2019; 11: 47-89 https://doi.org/10.7759/cureus.4789
Ehrmann D, Kulzer B, Roos T, Haak T, Al-Khatib M, Hermanns N. Risk factors and prevention strategies for diabetic ketoacidosis in people with established type 1 diabetes. The Lancet Diabetes Endocrinol 2020; 8: 436-446. https://doi.org/10.1016/s2213-8587(20)30042-5
Rosenbloom AL. Intracerebral crises during treatment of diabetic ketoacidosis. Diabetes Care. 1990; 13: 22–33. https://doi.org/10.2337/diacare.13.1.22
Jovanovic A, Stolic RV, Rasic DV, Markovic-Jovanovic SR, Peric VM. Stroke and diabetic ketoacidosis–some diagnostic and therapeutic considerations. Vasc Health Risk Manag 2014; 10: 201-204. https://doi.org/10.2147/VHRM.S59593
Foster JR, Morrison G, Fraser DD. Diabetic ketoacidosis-associated stroke in children and youth. Stroke Res Treat 2011; 22: 4 2011:219706. https://doi.org/10.4061/2011/219706
CDC Growth Charts. Available at https://www.cdc.gov/growthcharts/clinical_charts.htm (Accessed on 01 July 2021.)
Bialo SR, Agrawal S, Boney CM, Quintos JB. Rare complications of Paediatric diabetic ketoacidosis. World J Diabetes 2015; 6: 167-174. https://doi.org/10.4239/wjd.v6.i1.167
Levin DL. Cerebral edema in diabetic ketoacidosis. Pediatric Critical Care Medicine 2008; 9: 320-329. https://doi.org/10.1097/PCC.0b013e31816c7082
Azova S, Rapaport R, Wolfsdorf J. Brain injury in children with diabetic ketoacidosis: Review of the literature and a proposed pathophysiologic pathway for the development of cerebral oedema. Pediatr Diabetes 2021; 22: 148-160. https://doi.org/10.1111/pedi.13152
Glaser NS, Ghetti S, Casper TC, Dean JM, Kuppermann N, Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group. Pediatric diabetic ketoacidosis, fluid therapy, and cerebral injury: the design of a factorial randomized controlled trial. Pediatric Diabetes 2013; 14): 435-446. https://doi.org/10.1111/pedi.12027
Oludare OI, Oluwasola OJ, Fesojaye TA. Cerebrovascular disease in a newly diagnosed diabetic adolescent: case report. Endocrinol Metab Int J 2017; 5: 185-186. https://doi.org/10.15406/emij.2017.05.00114
Gosmanov AR, Gosmanova EO, Kitabchi AE. Hyperglycemic crises: diabetic ketoacidosis (DKA), and hyperglycemic hyperosmolar state (HHS). In: Endotext [Internet]. South Darthmouth (MA): MD Text.com. Inc,; 2000- 2021 May 09.
Ferriero DM, Fullerton HJ, Bernard TJ, Billinghurst L, Daniels SR, DeBaun MR, deVeber G, Ichord RN, Jordan LC, Massicotte P, Meldau J. Management of stroke in neonates and children: a scientific statement from the American Heart Association/American Stroke Association. Stroke 2019; 50: e51-e96. https://doi.org/10.1161/STR.0000000000000183
Downloads
Published
Issue
Section
License
The articles and other materials published in the Annals of Health Research are protected by the Nigerian Copyright laws. The journal owns the copyright over every article, scientific and intellectual materials published in it. However, the journal grants all authors, users and researchers access to the materials published in the journal with the permission to copy, use and distribute the materials contained therein only for academic, scientific and non-commercial purposes.
