Coma with diffuse white matter hemorrhages in juvenile diabetic ketoacidosis

Area of Science:

• Neurology
• Pediatrics
• Endocrinology

Background:

• Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus.
• Neurologic complications, particularly cerebral edema, are well-documented in pediatric DKA.
• Cerebrovascular accidents are less common but recognized neurological events in DKA.

Observation:

• This report details two adolescent patients with DKA who presented with coma.
• These patients exhibited diffuse white matter hemorrhages.
• Notably, neither cerebral edema nor cerebrovascular accidents were present in these cases.

Findings:

• The cases present a novel neuropathologic finding of diffuse white matter hemorrhages in DKA.
• A cytotoxic process is suggested as a potential underlying mechanism for these hemorrhages.
• This challenges the typical understanding of DKA-related neurological pathology.

Implications:

• Pediatric DKA with coma can manifest with neurological pathologies beyond cerebral edema and stroke.
• These findings expand the spectrum of DKA-induced neurological complications.
• Further research into cytotoxic mechanisms in DKA is warranted for improved patient management.