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Stroke Research and Treatment
Volume 2011 (2011), Article ID 219706, 12 pages
http://dx.doi.org/10.4061/2011/219706
Review Article

Diabetic Ketoacidosis-Associated Stroke in Children and Youth

1Critical Care Medicine and Paediatrics, University of Western Ontario, London, ON, Canada N6A 5W9
2Children's Health Research Institute, London, ON, Canada N6C 2V5
3Centre for Critical Illness Research, London, ON, Canada N6C 2V5
4Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada N6A 3K7
5Physiology and Pharmacology, University of Western Ontario, London, ON, Canada N6A 3K7
6Translational Research Centre, London, ON, Canada N6C 2V5

Received 8 October 2010; Revised 12 November 2010; Accepted 4 December 2010

Academic Editor: Halvor Naess

Copyright © 2011 Jennifer Ruth Foster et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Diabetic ketoacidosis (DKA) is a state of severe insulin deficiency, either absolute or relative, resulting in hyperglycemia and ketonemia. Although possibly underappreciated, up to 10% of cases of intracerebral complications associated with an episode of DKA, and/or its treatment, in children and youth are due to hemorrhage or ischemic brain infarction. Systemic inflammation is present in DKA, with resultant vascular endothelial perturbation that may result in coagulopathy and increased hemorrhagic risk. Thrombotic risk during DKA is elevated by abnormalities in coagulation factors, platelet activation, blood volume and flow, and vascular reactivity. DKA-associated cerebral edema may also predispose to ischemic injury and hemorrhage, though cases of stroke without concomitant cerebral edema have been identified. We review the current literature regarding the pathogenesis of stroke during an episode of DKA in children and youth.