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Updated: Jun 25, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Diabetic ketoacidosis with central nervous system involvement: Conventional and advanced magnetic resonance
Luca Caschera1, Giorgio Fiore2,3, Simone Nava1
1Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy.
Insights
Diabetic ketoacidosis (DKA) in children with type 1 diabetes can cause severe brain injury. Advanced MRI revealed potential brain reorganization for sensory function despite significant damage, offering prognostic insights.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Endocrinology
Background:
- Diabetic ketoacidosis (DKA) is a severe complication of type 1 diabetes mellitus (DM1) in children.
- Rarely, DKA can lead to serious central nervous system (CNS) complications, including cerebral edema, herniation, and infarction.
Purpose of the Study:
- To present neuroimaging findings in a pediatric DKA case with CNS involvement.
- To evaluate white matter integrity and cortical sensory processing using advanced MRI techniques.
Main Methods:
- Conventional MRI, diffusion tensor imaging (DTI), and functional MRI (fMRI) were employed.
- Assessment focused on white matter integrity and sensory pathway function.
Main Results:
- Conventional MRI revealed signs of central brain herniation and intracranial hypertension, including uncal herniation, cistern effacement, PCA territory infarcts, brainstem sagging, and Duret's hemorrhage.
- Advanced MRI suggested possible left-sided cortical reorganization for sensory function, with less severe impairment in underlying left cortico-thalamic and cortico-spinal pathways.
Conclusions:
- DKA can cause extensive CNS damage, including signs of brain herniation and infarction.
- Advanced neuroimaging techniques like DTI and fMRI may identify adaptive brain changes and serve as prognostic indicators in pediatric DKA with CNS involvement.
Abstract:
Diabetic ketoacidosis (DKA) is a serious complication in children with diabetes mellitus type 1 (DM1). In rare and severe cases DKA may be complicated by cerebral edema, central brain herniation and cerebral infarctions. We present the magnetic resonance imaging findings in a child with DKA and central nervous system involvement; diffusion tensor imaging (DTI) and functional MRI (fMRI) were performed to assess the white matter integrity of sensory pathways and cortical sensory processing. Conventional imaging showed bilateral uncal herniation, effacement of the perimesencephalic cisterns, wide ischemic lesions in the posterior cerebral artery (PCA) territories, sagging brainstem and Duret's hemorrhage consistent with signs of central brain herniation and intracranial hypertension. Advanced MRI showed a possible left-sided cortical reorganization for sensory function, with underlying left cortico-talamic and cortico-spinal pathways less severely impaired. Knowledge of the full framework in these conditions is of vital importance for timely patient management; advanced neuroimaging techniques may be considered as prognostic indicators in those cases with extensive involvement of eloquent brain areas.
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