Cargando…

Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus

Cerebral oedema is the most common neurological complication of diabetic ketoacidosis (DKA). However, ischaemic and haemorrhagic brain injury has been reported infrequently. A 10-year old girl who was previously well presented with severe DKA. She was tachycardic with poor peripheral perfusion but n...

Descripción completa

Detalles Bibliográficos
Autores principales: Mohd Nor, Noor Shafina, Fong, Choong Yi, Rahmat, Kartini, Vanessa Lee, Wan Mun, Zaini, Azriyanti Anuar, Jalaludin, Muhammad Yazid
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Touch Medical Media 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954598/
https://www.ncbi.nlm.nih.gov/pubmed/29922355
http://dx.doi.org/10.17925/EE.2018.14.1.59
_version_ 1783323550490296320
author Mohd Nor, Noor Shafina
Fong, Choong Yi
Rahmat, Kartini
Vanessa Lee, Wan Mun
Zaini, Azriyanti Anuar
Jalaludin, Muhammad Yazid
author_facet Mohd Nor, Noor Shafina
Fong, Choong Yi
Rahmat, Kartini
Vanessa Lee, Wan Mun
Zaini, Azriyanti Anuar
Jalaludin, Muhammad Yazid
author_sort Mohd Nor, Noor Shafina
collection PubMed
description Cerebral oedema is the most common neurological complication of diabetic ketoacidosis (DKA). However, ischaemic and haemorrhagic brain injury has been reported infrequently. A 10-year old girl who was previously well presented with severe DKA. She was tachycardic with poor peripheral perfusion but normotensive. However, two fast boluses totalling 40 ml/kg normal saline were given. She was transferred to another hospital where she was intubated due to drowsiness. Rehydration fluid (maintenance and 48-hour correction for 7.5% dehydration) was started followed by insulin infusion. She was extubated within 24 hours of admission. Her ketosis resolved soon after and subcutaneous insulin was started. However, about 48 hours after admission, her Glasgow Coma Scale score dropped to 11/15 (E4M5V2) with expressive aphasia and upper motor neuron signs. One dose of mannitol was given. Her symptoms improved gradually and at 26-month follow-up she had a near-complete recovery with only minimal left lower limb weakness. Serial magnetic resonance imaging brain scans showed vascular ischaemic injury at the frontal-parietal watershed regions with haemorrhagic transformation. This case reiterates the importance of monitoring the neurological status of patient’s with DKA closely for possible neurological complications including an ischaemic and haemorrhagic stroke.
format Online
Article
Text
id pubmed-5954598
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Touch Medical Media
record_format MEDLINE/PubMed
spelling pubmed-59545982018-06-19 Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus Mohd Nor, Noor Shafina Fong, Choong Yi Rahmat, Kartini Vanessa Lee, Wan Mun Zaini, Azriyanti Anuar Jalaludin, Muhammad Yazid Eur Endocrinol Diabetes Cerebral oedema is the most common neurological complication of diabetic ketoacidosis (DKA). However, ischaemic and haemorrhagic brain injury has been reported infrequently. A 10-year old girl who was previously well presented with severe DKA. She was tachycardic with poor peripheral perfusion but normotensive. However, two fast boluses totalling 40 ml/kg normal saline were given. She was transferred to another hospital where she was intubated due to drowsiness. Rehydration fluid (maintenance and 48-hour correction for 7.5% dehydration) was started followed by insulin infusion. She was extubated within 24 hours of admission. Her ketosis resolved soon after and subcutaneous insulin was started. However, about 48 hours after admission, her Glasgow Coma Scale score dropped to 11/15 (E4M5V2) with expressive aphasia and upper motor neuron signs. One dose of mannitol was given. Her symptoms improved gradually and at 26-month follow-up she had a near-complete recovery with only minimal left lower limb weakness. Serial magnetic resonance imaging brain scans showed vascular ischaemic injury at the frontal-parietal watershed regions with haemorrhagic transformation. This case reiterates the importance of monitoring the neurological status of patient’s with DKA closely for possible neurological complications including an ischaemic and haemorrhagic stroke. Touch Medical Media 2018-04 2018-04-18 /pmc/articles/PMC5954598/ /pubmed/29922355 http://dx.doi.org/10.17925/EE.2018.14.1.59 Text en © The Author(s) 2018 http://creativecommons.org/licenses/by-nc/3.0/ This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. © The Authors 2018. Compliance with Ethics: All procedures were followed in accordance with the responsible committee on human experimentation and with the Helsinki Declaration of 1975 and subsequent revisions, and that informed consent was received from the parents and patient involved in the study. The case report has obtained the approval from the IRB of University Malaya Medical Center. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.
spellingShingle Diabetes
Mohd Nor, Noor Shafina
Fong, Choong Yi
Rahmat, Kartini
Vanessa Lee, Wan Mun
Zaini, Azriyanti Anuar
Jalaludin, Muhammad Yazid
Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus
title Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus
title_full Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus
title_fullStr Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus
title_full_unstemmed Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus
title_short Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus
title_sort ischaemic haemorrhagic stroke in a child with new onset type 1 diabetes mellitus
topic Diabetes
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954598/
https://www.ncbi.nlm.nih.gov/pubmed/29922355
http://dx.doi.org/10.17925/EE.2018.14.1.59
work_keys_str_mv AT mohdnornoorshafina ischaemichaemorrhagicstrokeinachildwithnewonsettype1diabetesmellitus
AT fongchoongyi ischaemichaemorrhagicstrokeinachildwithnewonsettype1diabetesmellitus
AT rahmatkartini ischaemichaemorrhagicstrokeinachildwithnewonsettype1diabetesmellitus
AT vanessaleewanmun ischaemichaemorrhagicstrokeinachildwithnewonsettype1diabetesmellitus
AT zainiazriyantianuar ischaemichaemorrhagicstrokeinachildwithnewonsettype1diabetesmellitus
AT jalaludinmuhammadyazid ischaemichaemorrhagicstrokeinachildwithnewonsettype1diabetesmellitus