Table 1: Case reports of arterial ischemic stroke, cerebral venous thrombotic stroke, and hemorrhagic stroke associated with an episode of DKA in children and youth.

Patient numberAge (year)GenderPathologic findingsClinical PresentationOutcomeCoagulation profileReference number

Arterial Ischemic Stroke.

10.25femaleMultiple small vessel thrombi with edema on autopsyFirst presentation diabetes, generalized seizure, progressive coma on admissionDeath at 24 hours [13]

24femaleInfarction, right posterior cerebral artery distributionFirst presentation diabetes, decerebrate posturing, acute herniationSlowly regained ability to walk and comprehend speechLow protein C normalized with treatment, elevated Factor VIII-vWF complex, elevated plasma and platelet thromboxane B2 [14]

38maleInfarction of left thalamus, left temporal lobe, B/L occipital lobesDecerebrate posturingSlow recoveryLow protein C antigen, normalized [14]

410unknownBasilar artery thrombosis on CTRestless, decreasing LOC over 4.5 hours, respiratory arrest at 7 hoursPersistent vegetative state [4]

514femaleCT edema and infarction of left lentiform nucleus, thalami, B/L pedunclesHeadache, deteriorating LOC. Pupils midline, fixed, dilated after 12 hoursMild left hemiparesis, behavioral disturbances [15]

65maleInfarction left posterior cerebral artery distribution, geniculate nuclei, left thalamusFirst presentation diabetes, generalized seizureModerate left hemiplegiaLow protein S, elevated factor VIII and factor V [5]

76maleInfarction B/L anterior cerebral artery distributions, basal ganglia, left cingulate gyrusFirst presentation diabetes, lethargy and posturing of upper extremitiesEmotionally labile, intellectual and motor impairmentLow AT III antigen, AT III functionally normal, increased platelet aggregation [5]

87maleIschemia in globus pallidus, B/L cingulate gyri. Infarctions left thalamus, right medial occipital lobe. No CT edemaFirst presentation diabetes, decreased level of consciousness with incontinence, stiffness, pupils poorly reactiveHemiplegia, normal cognition, abnormal behavior and affect,Decreased platelet aggregation [5]

98maleInfarction thalamus, midbrain, basal ganglia, cingulated gyrus. No CT edemaFirst presentation diabetes, unresponsive, flaccid, pupils dilatedVegetative stateLow aPTT (21 seconds) [5]

1010maleInfarction right anterior cerebral artery distribution, left putamen, B/L globus pallidusFirst presentation diabetes, decreased LOC, left extensor posturing, abnormal papillary responseSevere focal neurologic impairment [5]

116femaleInfarction proximal left middle cerebral artery, left basal gangliaFirst presentation diabetes, irritability, lethargy, right hemiparesis, aphasia. Had 2 mitral valve thrombiRegained speech, residual right hemiparesisNormal pro-thrombotic studies [6]

1218femaleInfarction right common carotid artery territory with distal emboli in right anterior and middle cerebral arteriesFirst presentation diabetes, left hemiparesis 10 hours after carotid artery punctureModerate clinical recovery [16]

Cerebral Venous Thrombosis.

135femaleThrombosis of straight sinus and vein of Galen. Infarction of basal ganglia, thalamusConfusion, decreased LOC, rigidity, fisting. Significant iron deficiency anemiaMild learning difficultiesNormal clotting screen and thrombophilia screen [17]

1411maleMultiple areas of infarction on MRI without hemorrhage or edemaHeadache, nausea and vomiting, acute deterioration with fixed, dilated pupils. Had DVT of right superficial femoral and popliteal veinsBrain deathDecreased protein C function (36%), normal protein S and factor VIII, no anticardiolipins. Heterozygous factor V Leiden [18]

1519femaleSuperior sagittal sinus thrombosisFirst presentation diabetes. Anxiety progressed to psychosis, dysphasia, left abducens palsy, right inferior facial palsy, tetraparCsis with upper motor neuron signsPartial left abducens paresis with diplopia which resolvedcoagulopathy screen negative [19]

168maleVein of galen and superior sagittal sinus thrombosis. B/L medial cerebral hemisphere infarctionsFirst presentation diabetes, loss of consciousness, sluggish pupillary reaction, feverGCS remained 6 when transferred to another hospitalLow platelets, decreased ATIII (60.4%) increased with treatment, elevated D-dimer, increased with treatment [20]

171.1femaleLeft transverse sinus thrombosis, no infarctionFirst presentation of thiamine-responsive megaloblastic anemia, associated with nonimmune insulin-dependent diabetes. Right-sided focal seizureNormal neurologic statusProthrombotic screening negative [16]

1810femaleThrombosis of superior sagittal, straight, right transverse, right sigmoid and proximal posterior left transverse sinusesHeadache, 6th cranial nerve palsy day 3, decreased level of consciousness day 5Recombinant tPA thrombolysis, complete recoveryHeterozygous mutation of the prothrombin gene (G20210A) [21]

Hemorrhagic infarction.

1911femaleMultiple large, B/L posterior temporal lobe hematomasBehavioral disturbance, lethargy, progressed to unresponsive, pupils dilated and unreactiveNormal neurologic exam [22]

201unknownSubarachnoid hemorrhage on CTSudden respiratory arrestDied at 2 days [4]

2111unknownSubarachnoid hemorrhage on CTProgressively worsening neurologic statusDeath [4]

226.5unknownCT suggestive of subarachnoid hemorrhageSevere headache and restless. Pupils fixed, dilated at 3 hours, respiratory arrest at 6 hoursDeath [4]

239femaleHemorrhagic infarction right caudate nucleus, anterior limb of internal capsule. Non-hemorrhagic infarction of B/L thalami with edemaAtaxia, deteriorating LOC, abnormal respiratory pattern,. Developed decorticate posturing, right-sided tonic seizureCommunication disorder, asymmetric spastic quadriparesis, behavior disturbances. [15]

249femaleEdema and hemorrhagic infarctions basal ganglia, upper brain stem, medial temporal lobes, frontal lobes, occipital lobesDecreased LOC, left exotropia, unequal and unreactive pupils, papilledemaQuadriplegia, absent oculocephalic reflexes, central right facial paresis, profound cognitive defects [15]

2515femaleNo cerebral edema in first 24 hours on CT. Multiple small hematomas, mainly parieto-occipital, on day 12 MRIFirst episode diabetes. Significant hypotension, unconscious at presentation. Neurologically normal day 4. Bilateral knee clonus, extensor plantar response and peripheral nerve palsies on day 7Decreased platelets (85,000), normal coagulation profile [23]

2611femaleNormal MRI. On autopsy: pin-point hemorrhages with ring-and-ball morphology in hemispheric white matter, throughout brainstem and spinal cordFirst presentation diabetes, Hypotension, rapid deterioration in LOCDeath from renal complications Normal coagulation studies [24]

2714femalePetechial hemorrhages in B/L subcortical white matter U fibers, genu of corpus callosum, posterior limb of internal capsule, frontal lobe on MRIFirst presentation diabetes, significant hypotension. Unresponsive and dyspneicShort term memory loss, moderate cognitive deficitsNormal coagulation studies [24]

285femaleHemorrhagic infarct left thalamusFirst presentation diabetes. Right central facial palsy, right hemiplegia, right babinski sign on day 7 of treatmentMild learning difficultiesnormal bleeding studies, normal protein C and S at time of hemorrhage [25]

LOC: level of consciousness; B/L: bilateral; tPA: tissue plasminogen activator.