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Regional Brain Water Content and Distribution During Diabetic Ketoacidosis
Nicole S Glaser1, Sandra L Wootton-Gorges2, Isaac Kim2
1Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, CA.
Insights
Diabetic ketoacidosis (DKA) causes brain swelling, particularly in areas with high blood flow. The brainstem, however, may experience reduced blood flow during DKA, unlike other brain regions.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes.
- Brain edema is a significant concern in pediatric DKA.
- Understanding regional brain changes during DKA is crucial for patient management.
Purpose of the Study:
- To investigate regional differences in brain water content during DKA in children.
- To correlate these brain changes with regional vascular supply.
- To identify potential differences in brainstem involvement during DKA.
Main Methods:
- Magnetic resonance diffusion-weighted imaging (DWI) was used to assess brain water distribution.
- Apparent diffusion coefficient (ADC) of water was measured in various brain regions.
- Brain water content was quantified in a subset of pediatric patients during DKA and after recovery.
Main Results:
- Elevated ADC values, indicating vasogenic cerebral edema, were observed in the frontal cortex, basal ganglia, thalamus, and hippocampus during DKA.
- The medulla and occipital cortex showed no significant ADC increase during DKA.
- Regions supplied by the anterior/middle cerebral artery exhibited greater increases in ADC and water content compared to posterior cerebral artery-supplied regions.
Conclusions:
- Brainstem ADC changes during DKA differ from other brain regions.
- Regional variations in brain water content correlate with vascular supply territories.
- These findings suggest potential reduced brainstem blood flow during DKA, contrasting with hyperemia in other areas.
Objective:
To characterize regional differences in brain water distribution and content during diabetic ketoacidosis (DKA) in children and determine whether these differences correlate with regional vascular supply.
Study Design:
We compared changes in brain water distribution and water content in different brain regions during DKA by analyzing magnetic resonance diffusion weighted imaging data collected during DKA and after recovery in 45 children (<18 years of age). We measured the apparent diffusion coefficient (ADC) of water in the frontal and occipital cortex, basal ganglia, thalamus, hippocampus, and medulla. Brain water content was also measured in a subset of patients.
Results:
ADC values were elevated (suggesting vasogenic cerebral edema) in the frontal cortex, basal ganglia, thalamus, and hippocampus during DKA. In contrast, ADC values in the medulla and the occipital cortex were not increased during DKA, and ADC changes in the medulla tended to be negatively correlated with other regions. Regions supplied by the anterior/middle cerebral artery circulation had greater elevations in both ADC and brain water content during DKA compared with regions supplied by the posterior cerebral artery circulation.
Conclusions:
ADC changes during DKA in the brainstem contrast with those of other brain regions, and changes in both ADC and brain water content during DKA vary according to regional vascular supply. These data suggest that brainstem blood flow might possibly be reduced during DKA concurrent with hyperemia in other brain regions.
