- About this Journal
- Abstracting and Indexing
- Aims and Scope
- Annual Issues
- Article Processing Charges
- Articles in Press
- Author Guidelines
- Bibliographic Information
- Citations to this Journal
- Contact Information
- Editorial Board
- Editorial Workflow
- Free eTOC Alerts
- Publication Ethics
- Reviewers Acknowledgment
- Submit a Manuscript
- Subscription Information
- Table of Contents
Stroke Research and Treatment
Volume 2011 (2011), Article ID 219706, 12 pages
Diabetic Ketoacidosis-Associated Stroke in Children and Youth
1Critical Care Medicine and Paediatrics, University of Western Ontario, London, ON, N6A 5W9, Canada
2Children's Health Research Institute, London, ON, N6C 2V5, Canada
3Centre for Critical Illness Research, London, ON, N6C 2V5, Canada
4Clinical Neurological Sciences, University of Western Ontario, London, ON, N6A 3K7, Canada
5Physiology and Pharmacology, University of Western Ontario, London, ON, N6A 3K7, Canada
6Translational Research Centre, London, ON, N6C 2V5, Canada
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.
- J. Wolfsdorf, N. Glaser, and M. A. Sperling, “Diabetic ketoacidosis in infants, children, and adolescents: a consensus statement from the American Diabetes Association,” Diabetes Care, vol. 29, no. 5, pp. 1150–1159, 2006.
- J. Scibilia, D. Finegold, J. Dorman, D. Becker, and A. Drash, “Why do children with diabetes die?” Acta Endocrinologica. Supplementum, vol. 279, pp. 326–333, 1986.
- J. A. Edge, M. E. Ford-Adams, and D. B. Dunger, “Causes of death in children with insulin dependent diabetes 1990-96,” Archives of Disease in Childhood, vol. 81, no. 4, pp. 318–323, 1999.
- A. L. Rosenbloom, “Intracerebral crises during treatment of diabetic ketoacidosis,” Diabetes Care, vol. 13, no. 1, pp. 22–33, 1990.
- T. F. Roe, T. O. Crawford, K. R. Huff, G. Costin, F. R. Kaufman, and M. D. Nelson, “Brain infarction in children with diabetic ketoacidosis,” Journal of Diabetes and its Complications, vol. 10, no. 2, pp. 100–108, 1996.
- J. Ho, D. Pacaud, M. D. Hill, C. Ross, L. Hamiwka, and J. K. Mah, “Diabetic ketoacidosis and pediatric stroke,” Canadian Medical Association Journal, vol. 172, no. 3, pp. 327–328, 2005.
- J. A. Edge, M. M. Hawkins, D. L. Winter, and D. B. Dunger, “The risk and outcome of cerebral oedema developing during diabetic ketoacidosis,” Archives of Disease in Childhood, vol. 85, no. 1, pp. 16–22, 2001.
- S. E. Lawrence, E. A. Cummings, I. Gaboury, and D. Daneman, “Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis,” Journal of Pediatrics, vol. 146, no. 5, pp. 688–692, 2005.
- A. L. Rosenbloom, “Hyperglycemic crises and their complications in children,” Journal of Pediatric Endocrinology and Metabolism, vol. 20, no. 1, pp. 5–18, 2007.
- S. Likitmaskul, J. Santiprabhob, P. Sawathiparnich, N. Numbenjapon, and K. Chaichanwatanakul, “Clinical pictures of type 2 diabetes in Thai children and adolescents is highly related to features of metabolic syndrome,” Journal of the Medical Association of Thailand, vol. 88, supplement 8, pp. S169–S175, 2005.
- R. L. Sacco, “Risk factors and outcomes for ischemic stroke,” Neurology, vol. 45, no. 2, pp. S10–14, 1995.
- . The Emerging Risk Factors Collaboration, “Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies,” The Lancet, vol. 375, no. 9733, pp. 2215–2222, 2010.
- W. R. Timperley, F. E. Preston, and J. D. Ward, “Cerebral intravascular coagulation in diabetic ketoacidosis,” The Lancet, vol. 1, no. 7864, pp. 952–956, 1974.
- R. K. Kanter, M. Oliphant, J. J. Zimmerman, and M. J. Stuart, “Arterial thrombosis causing cerebral edema in association with diabetic ketoacidosis,” Critical Care Medicine, vol. 15, no. 2, pp. 175–176, 1987.
- B. Rogers, I. Sills, M. Cohen, and F. G. Seidel, “Diabetic Ketoacidosis: neurologic collapse during treatment followed by severe developmental morbidity,” Clinical Pediatrics, vol. 29, no. 8, pp. 451–456, 1990.
- J. Ho, J. K. Mah, M. D. Hill, and D. Pacaud, “Pediatric stroke associated with new onset type 1 diabetes mellitus: case reports and review of the literature,” Pediatric Diabetes, vol. 7, no. 2, pp. 116–121, 2006.
- S. Keane, A. Gallagher, S. Ackroyd, M. A. McShane, and J. A. Edge, “Cerebral venous thrombosis during diabetic ketoacidosis,” Archives of Disease in Childhood, vol. 86, no. 3, pp. 204–206, 2002.
- A. L. Rosenbloom, “Fatal cerebral infarctions in diabetic ketoacidosis in a child with previously unknown heterozygosity for factor V Leiden deficiency,” Journal of Pediatrics, vol. 145, no. 4, pp. 561–562, 2004.
- K. De Keyzer, K. Paemeleire, M. De Clerck, D. Peeters, and J. L. De Reuck, “Diabetic ketoacidosis presenting as a cerebral venous sinus thrombosis,” Acta Neurologica Belgica, vol. 104, no. 3, pp. 117–120, 2004.
- M. J. Sasiadek, D. Sosnowska-Pacuszko, M. Zielinska, and T. Turek, “Cerebral venous thrombosis as a first presentation of diabetes,” Pediatric Neurology, vol. 35, no. 2, pp. 135–138, 2006.
- M. Zerah, R. Patterson, I. Hansen, M. Briones, J. Dion, and B. Renfroe, “Resolution of severe sinus vein thrombosis with super selective thrombolysis in a pre-adolescent with diabetic ketoacidosis and a prothrombin gene mutation,” Journal of Pediatric Endocrinology and Metabolism, vol. 20, no. 6, pp. 725–731, 2007.
- V. L. Atluru, “Spontaneous intracerebral hematomas in juvenile diabetic ketoacidosis,” Pediatric Neurology, vol. 2, no. 3, pp. 167–169, 1986.
- S. L. Atkin, A. M. Coady, D. Horton, N. Sutaria, L. Sellars, and C. Walton, “Multiple cerebral haematomata and peripheral nerve palsies associated with a case of juvenile diabetic ketoacidosis,” Diabetic Medicine, vol. 12, no. 3, pp. 267–270, 1995.
- F. H. Mahmud, D. A. Ramsay, S. D. Levin, R. N. Singh, T. Kotylak, and D. D. Fraser, “Coma with diffuse white matter hemorrhages in juvenile diabetic ketoacidosis,” Pediatrics, vol. 120, no. 6, pp. e1540–e1546, 2007.
- J. J. Lin, K. L. Lin, H. S. Wang, A. M. C. Wong, and S. H. Hsia, “Occult infarct with acute hemorrhagic stroke in juvenile diabetic ketoacidosis,” Brain and Development, vol. 30, no. 1, pp. 91–93, 2008.
- W. H. Hoffman, C. L. Burek, J. L. Waller, L. E. Fisher, M. Khichi, and L. B. Mellick, “Cytokine response to diabetic ketoacidosis and its treatment,” Clinical Immunology, vol. 108, no. 3, pp. 175–181, 2003.
- C. G. Schalkwijk, D. C. W. Poland, W. Van Dijk et al., “Plasma concentration of C-reactive protein is increased in Type I diabetic patients without clinical macroangiopathy and correlates with markers of endothelial dysfunction: evidence for chronic inflammation,” Diabetologia, vol. 42, no. 3, pp. 351–357, 1999.
- R. R. Dalton, W. H. Hoffman, G. G. Passmore, and S. L. A. Martin, “Plasma C-reactive protein levels in severe diabetic ketoacidosis,” Annals of Clinical and Laboratory Science, vol. 33, no. 4, pp. 435–442, 2003.
- W. H. Hoffman, C. D. Cudrici, E. Zafranskaia, and H. Rus, “Complement activation in diabetic ketoacidosis brains,” Experimental and Molecular Pathology, vol. 80, no. 3, pp. 283–288, 2006.
- A. Ceriello, D. Giugliano, A. Quatraro, E. Marchi, M. Barbanti, and P. Lefebvre, “Possible role for increased C4b-binding-protein level in acquired protein S deficiency in type I diabetes,” Diabetes, vol. 39, no. 4, pp. 447–449, 1990.
- S. K. Jain, R. McVie, and J. A. Bocchini Jr., “Hyperketonemia (ketosis), oxidative stress and type 1 diabetes,” Pathophysiology, vol. 13, no. 3, pp. 163–170, 2006.
- W. H. Hoffman, J. P. Locksmith, E. M. Burton et al., “Interstitial pulmonary edema in children and adolescents with diabetic ketoacidosis,” Journal of Diabetes and its Complications, vol. 12, no. 6, pp. 314–320, 1998.
- R. Bonfanti, E. Bognetti, F. Meschi, S. Medaglini, A. D'Angelo, and G. Chiumello, “Disseminated intravascular coagulation and severe peripheral neuropathy complicating ketoacidosis in a newly diagnosed diabetic child,” Acta Diabetologica, vol. 31, no. 3, pp. 173–174, 1994.
- F. Shanahan, G. Mortimer, and M. I. Drury, “Cerebral intravascular coagulation complicating diabetic ketoacidosis,” Irish Journal of Medical Science, vol. 150, no. 5, pp. 156–157, 1981.
- N. Ş. Ileri, Y. Büyükaşik, S. Karaahmetoǧlu et al., “Evaluation of the haemostatic system during ketoacidotic deterioration of diabetes mellitus,” Haemostasis, vol. 29, no. 6, pp. 318–325, 2000.
- M. Romano, M. Pomilio, S. Vigneri et al., “Endothelial perturbation in children and adolescents with type 1 diabetes: association with markers of the inflammatory reaction,” Diabetes Care, vol. 24, no. 9, pp. 1674–1678, 2001.
- N. Doǧruel, B. Kirel, Y. Akgün, and T. Us, “Serum soluble endothelial-cell specific adhesion molecules in children with insulin-dependent diabetes mellitus,” Journal of Pediatric Endocrinology and Metabolism, vol. 14, no. 3, pp. 287–293, 2001.
- M. E. Carr, “Diabetes mellitus: a hypercoagulable state,” Journal of Diabetes and its Complications, vol. 15, no. 1, pp. 44–54, 2001.
- T. Sakamoto, H. Ogawa, H. Kawano et al., “Rapid change of platelet aggregability in acute hyperglycemia. Detection by a novel laser-light scattering method,” Thrombosis and Haemostasis, vol. 83, no. 3, pp. 475–479, 2000.
- A. Iorio, M. O. Federici, E. Mourvaki et al., “Impaired endothelial antithrombotic activity following short-term interruption of continous subcutaneous insulin infusion in type I diabetic patients,” Thrombosis and Haemostasis, vol. 98, no. 3, pp. 635–641, 2007.
- G. F. Carl, W. H. Hoffman, G. G. Passmore et al., “Diabetic ketoacidosis promotes a prothrombotic state,” Endocrine Research, vol. 29, no. 1, pp. 73–82, 2003.
- J. M. Worly, J. D. Fortenberry, I. Hansen, C. R. Chambliss, and J. Stockwell, “Deep venous thrombosis in children with diabetic ketoacidosis and femoral central venous catheters,” Pediatrics, vol. 113, no. 1, pp. e57–e60, 2004.
- J. A. Gutierrez, R. Bagatell, M. P. Samson, A. A. Theodorou, and R. A. Berg, “Femoral central venous catheter-associated deep venous thrombosis in children with diabetic ketoacidosis,” Critical Care Medicine, vol. 31, no. 1, pp. 80–83, 2003.
- C. Beck, J. Dubois, A. Grignon, J. Lacroix, and M. David, “Incidence and risk factors of catheter-related deep vein thrombosis in a pediatric intensive care unit: a prospective study,” Journal of Pediatrics, vol. 133, no. 2, pp. 237–241, 1998.
- T. C. Vukovich and G. Schernthaner, “Decreased protein C levels in patients with insulin-dependent type I diabetes mellitus,” Diabetes, vol. 35, no. 5, pp. 617–619, 1986.
- G. N. Welch and J. Loscalzo, “Homocysteine and atherothrombosis,” New England Journal of Medicine, vol. 338, no. 15, pp. 1042–1050, 1998.
- G. M. Rodgers and M. T. Conn, “Homocysteine, an atherogenic stimulus, reduces protein C activation by arterial and venous endothelial cells,” Blood, vol. 75, no. 4, pp. 895–901, 1990.
- M. Greaves, C. Pickering, and G. Knight, “Changes in the factor VIII complex in diabetic ketoacidosis: evidence of endothelial cell damage?” Diabetologia, vol. 30, no. 3, pp. 160–165, 1987.
- R. C. Paton, “Haemostatic changes in diabetic coma,” Diabetologia, vol. 21, no. 3, pp. 172–177, 1981.
- M. Mirshahi, J. Soria, C. Soria, O. Bertrand, M. Mirshahi, and A. Basdevant, “Glycosylation of human fibrinogen and fibrin in vitro. Its consequences on the properties of fibrin(ogen),” Thrombosis Research, vol. 48, no. 3, pp. 279–289, 1987.
- M. E. Carr and B. M. Alving, “Effect of fibrin structure on plasmin-mediated dissolution of plasma clots,” Blood Coagulation and Fibrinolysis, vol. 6, no. 6, pp. 567–573, 1995.
- M. R. Adams, C. J. Forsyth, W. Jessup, J. Robinson, and D. S. Celermajer, “Oral L-arginine inhibits platelet aggregation but does not enhance endothelium-dependent dilation in healthy young men,” Journal of the American College of Cardiology, vol. 26, no. 4, pp. 1054–1061, 1995.
- D. Giugliano, R. Marfella, L. Coppola et al., “Vascular effects of acute hyperglycemia in humans are reversed by L- arginine: evidence for reduced availability of nitric oxide during hyperglycemia,” Circulation, vol. 95, no. 7, pp. 1783–1790, 1997.
- D. L. Sackett, “Possible risk factors in the development of venous thrombosis. Gastrointestinal disease, infection and dehydration,” The Milbank Memorial Fund quarterly, vol. 50, supplement 2, pp. 105–122, 1972.
- L. A. Evan-Wong, R. J. L. Davidson, and J. M. Stowers, “Alterations in erythrocytes in hyperosmolar diabetic decompensation: a pathophysiological basis for impaired blood flow and for an improved design of fluid therapy,” Diabetologia, vol. 28, no. 10, pp. 739–742, 1985.
- E. M. Sevick and R. K. Jain, “Effect of red blood cell rigidity on tumor blood flow: increase in viscous resistance during hyperglycemia,” Cancer Research, vol. 51, no. 10, pp. 2727–2730, 1991.
- C. M. Isales, L. Min, and W. H. Hoffman, “Acetoacetate and β-hydroxybutyrate differentially regulate endothelin-1 and vascular endothelial growth factor in mouse brain microvascular endothelial cells,” Journal of Diabetes and its Complications, vol. 13, no. 2, pp. 91–97, 1999.
- W. H. Hoffman, R. M. Pluta, A. Q. Fisher, M. B. Wagner, and J. A. Yanovski, “Transcranial Doppler ultrasound assessment of intracranial hemodynamics in children with diabetic ketoacidosis,” Journal of Clinical Ultrasound, vol. 23, no. 9, pp. 517–523, 1995.
- J. S. Roberts, M. S. Vavilala, K. A. Schenkman, D. Shaw, L. D. Martin, and A. M. Lam, “Cerebral hyperemia and impaired cerebral autoregulation associated with diabetic ketoacidosis in critically ill children,” Critical Care Medicine, vol. 34, no. 8, pp. 2217–2223, 2006.
- E. Beghi, G. Bogliun, G. Cavaletti et al., “Hemorrhagic infarction: risk factors, clinical and tomographic features, and outcome. A case-control study,” Acta Neurologica Scandinavica, vol. 80, no. 3, pp. 226–231, 1989.
- J. K. Lynch, “Cerebrovascular disorders in children,” Current Neurology and Neuroscience Reports, vol. 4, no. 2, pp. 129–138, 2004.
- A. B. Muir, R. G. Quisling, M. C. K. Yang, and A. L. Rosenbloom, “Cerebral edema in childhood diabetic ketoacidosis: natural history, radiographic findings, and early identification,” Diabetes Care, vol. 27, no. 7, pp. 1541–1546, 2004.
- N. Hoggard, I. D. Wilkinson, and P. D. Griffiths, “The imaging of ischaemic stroke,” Clinical Radiology, vol. 56, no. 3, pp. 171–183, 2001.
- W. Hirsch, R. Beck, C. Behrmann, A. Schobess, and R. P. Spielmann, “Reliability of cranial CT versus intracerebral pressure measurement for the evaluation of generalised cerebral oedema in children,” Pediatric Radiology, vol. 30, no. 7, pp. 439–443, 2000.
- B. Husson, G. Rodesch, P. Lasjaunias, M. Tardieu, and G. Sébire, “Magnetic resonance angiography in childhood arterial brain infarcts: a comparative study with contrast angiography,” Stroke, vol. 33, no. 5, pp. 1280–1285, 2002.
- D. S. Atkinson, “Computed Tomography of Pediatric Stroke,” Seminars in Ultrasound, CT and MRI, vol. 27, no. 3, pp. 207–218, 2006.
- B. Franklin, J. Liu, and F. Ginsberg-Fellner, “Cerebral edema and ophthalmoplegia reversed by mannitol in a new case of insulin-dependent diabetes mellitus,” Pediatrics, vol. 69, no. 1, pp. 87–90, 1982.
- M. Lopez-Vicente, S. Ortega-Gutierrez, C. Amlie-Lefond, and M. T. Torbey, “Diagnosis and Management of Pediatric Arterial Ischemic Stroke,” Journal of Stroke and Cerebrovascular Diseases, vol. 19, no. 3, pp. 175–183, 2010.
- D. Eleftheriou and V. Ganesan, “Controversies in childhood arterial ischemic stroke and cerebral venous sinus thrombosis,” Expert Review of Cardiovascular Therapy, vol. 7, no. 7, pp. 853–861, 2009.
- R. Belvís, “Thrombolysis for acute stroke in pediatrics,” Stroke, vol. 38, no. 6, pp. 1722–1723, 2007.
- M. I. Shuayto, J. I. Lopez, and F. Greiner, “Administration of intravenous tissue plasminogen activator in a pediatric patient with acute ischemic stroke,” Journal of Child Neurology, vol. 21, no. 7, pp. 604–606, 2006.
- S. L. Benedict, O. K. Ni, P. Schloesser, K. S. White, and J. F. Bale, “Intra-arterial thrombolysis in a 2-year-old with cardioembolic stroke,” Journal of Child Neurology, vol. 22, no. 2, pp. 225–227, 2007.
- C. Cognard, A. Weill, S. Lindgren, M. Piotin, L. Castaings, and J. Moret, “Basilar artery occlusion in a child: “Clot angioplasty” followed by thrombolysis,” Child's Nervous System, vol. 16, no. 8, pp. 496–500, 2000.
- A. Kirton, J. H. Wong, J. Mah et al., “Successful endovascular therapy for acute basilar thrombosis in an adolescent,” Pediatrics, vol. 112, no. 3, part 1, pp. e248–e251, 2003.
- P. Monagle, E. Chalmers, A. Chan et al., “Antithrombotic therapy in neonates and children: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition),” Chest, vol. 133, no. 6, supplement, pp. 887S–968S, 2008.
- E. S. Roach, M. R. Golomb, R. Adams et al., “Management of stroke in infants and children: a scientific statement from a special writing group of the american heart association stroke council and the council on cardiovascular disease in the young,” Stroke, vol. 39, no. 9, pp. 2644–2691, 2008.
- Paediatric Stroke Working Group, Stroke in Childhood: Clinical Guidelines for Diagnosis, Management and Rehabilitation, Royal College of Physicians, London ,UK, 2004.
- J. Burzynski, J. Ho, D. Pacaud, and J. Mah, “DKA and thrombosis,” Canadian Medical Association Journal, vol. 173, no. 2, pp. 132–133, 2005.
- D. B. Dunger, M. A. Sperling, C. L. Acerini et al., “European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and adolescents,” Pediatrics, vol. 113, no. 2, pp. e133–e140, 2004.
- M. L. Lawson, D. Pacaud, S. E. Lawrence, D. Daneman, and H. J. Dean, “2003 Canadian clinical practice guidelines for the management of diabetes in children and adolescents,” Paediatrics and Child Health, vol. 10, supplement A, pp. 5A–16A, 2005.