Life-saving decompressive craniectomy for diffuse cerebral edema during an episode of new-onset diabetic ketoacidosis

The case of a tachypneic 8-year-old exemplifies the diversity of etiologies for tachypnea and is a good reminder to avoid conformation bias given a patient’s history. In this case, the child has new onset diabetes and is in diabetic ketoacidosis (DKA). DKA is due to a deranged metabolism given the lack of insulin, leading to hyperglycemia, ketosis, and acidosis as well as dehydration. The chapter highlights the treatment including diligent rehydration and correction of acidosis. This is accomplished by restoring typical metabolic pathways with insulin all while closely monitoring and correcting changes in glucose and electrolytes. Finally, clinical symptoms are monitored closely to avoid pitfalls, which can include altered metal status, respiratory failure, cerebral edema, coma, and death.

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Functional Recovery after Decompressive Craniectomy for Cerebral Infarction

Neurosurgery ◽

10.1227/00006123-198808000-00002 ◽

1988 ◽

Vol 23 (2) ◽

pp. 143-147 ◽

Cited By ~ 79

Author(s):

Douglas Kondziolka ◽

Mahmood Fazl

Keyword(s):

Intracranial Pressure ◽

Cerebral Infarction ◽

Brain Stem ◽

Functional Recovery ◽

Decompressive Craniectomy ◽

Cerebral Edema ◽

Increased Intracranial Pressure ◽

Life Saving ◽

Impending Death ◽

Conventional Medical Therapy

ABSTRACT There is continuing controversy about the benefits of decompressive craniectomy in the treatment of lesions causing increased intracranial pressure (ICP) and brain edema. Laboratory work has shown a decrease in ICP after craniectomy, but also a paradoxical enhancement in the formation of underlying cerebral edema, which may act to the detriment of the patient. Since Rengachary et al. advocated craniectomy for massive cerebral infarction and reported their group of three patients, we have managed five patients with acute supratentorial cerebral infarction who progressed to uncal herniation and impending death from raised ICP and brain stem compression. All were treated with frontotemporal craniectomy after conventional medical therapy failed to achieve a response. All patients survived and are walking, despite a paresis appropriate to their original stroke. Two have returned to work. Good results with supratentorial craniectomy after infarction show that this procedure is life-saving and can also give acceptable functional recovery.

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Infantile cerebral infarction caused by severe diabetic ketoacidosis in new-onset type 1 diabetes mellitus

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2019-0233 ◽

2019 ◽

Vol 32 (12) ◽

pp. 1391-1394

Author(s):

Junichi Suzuki ◽

Tatsuo Fuchigami ◽

Kengo Kawamura ◽

Masako Aoki ◽

Tatsuhiko Urakami ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Cerebral Infarction ◽

Type 1 Diabetes Mellitus ◽

Diabetic Ketoacidosis ◽

Cerebral Edema ◽

Rare Complication ◽

Case Presentation ◽

New Onset

Abstract Background Diabetic ketoacidosis (DKA) is a common complication of type 1 diabetes mellitus (T1DM). Infants and children with new-onset T1DM may present with DKA, and the risk of cerebral edema is high in infantile DKA. What is new? Neurological deterioration during an episode of DKA is usually attributed to cerebral edema and cerebrovascular accidents. However, cerebral infarction is a very rare complication in infantile DKA. Case presentation We describe a rare case of infantile cerebral infarction caused by severe DKA in a patient with new-onset T1DM. Conclusions Cerebral infarction is an important intracranial complication in infantile DKA. Careful observation and treatment for DKA during the first 24 h of therapy are necessary in infants with new-onset T1DM because the risk of cerebral infarction is highest during this timeframe.

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Unusual Case of New Onset Diabetes Mellitus Presenting with Diabetic Ketoacidosis and Cerebral Edema with Literature Review

Journal of Nephrology & Therapeutics ◽

10.4172/2161-0959.1000262 ◽

2016 ◽

Vol 06 (05) ◽

Author(s):

Nitasa Sahu ◽

Emma Punni ◽

Chandra Chandran ◽

Medhat Ismail

Keyword(s):

Diabetes Mellitus ◽

Literature Review ◽

Diabetic Ketoacidosis ◽

Cerebral Edema ◽

Unusual Case ◽

Onset Diabetes ◽

New Onset Diabetes Mellitus ◽

New Onset

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A Rare and Lethal Complication: Cerebral Edema in the Adult Patient with Diabetic Ketoacidosis

Case Reports in Emergency Medicine ◽

10.1155/2018/5043752 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Christopher W. Meaden ◽

Beth J. Kushner ◽

Stacey Barnes

Keyword(s):

Diabetes Mellitus ◽

Emergency Department ◽

Case Report ◽

Diabetic Ketoacidosis ◽

Cerebral Edema ◽

Rare Complication ◽

Adult Population ◽

Uncontrolled Diabetes ◽

New Onset Diabetes Mellitus ◽

New Onset

Commonly seen in the emergency department, diabetic ketoacidosis is a potentially lethal sequela of uncontrolled diabetes mellitus. In the adult population, a rare complication of diabetic ketoacidosis is cerebral edema. This case report discusses a 26-year-old male with new onset diabetes mellitus who developed cerebral edema leading to death.

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Factors predicting cerebral edema in young children with diabetic ketoacidosis and new onset type I diabetes

Acta Paediatrica ◽

10.1111/j.1651-2227.1997.tb08946.x ◽

1997 ◽

Vol 86 (6) ◽

pp. 626-631 ◽

Cited By ~ 62

Author(s):

PM Hale ◽

I Rezvani ◽

AW Braunstein ◽

TH Lipman ◽

N Martinez ◽

...

Keyword(s):

Young Children ◽

Diabetic Ketoacidosis ◽

Cerebral Edema ◽

Type I Diabetes ◽

Type I ◽

Onset Type ◽

New Onset

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New onset diabetes with diabetic ketoacidosis in a child with multisystem inflammatory syndrome due to COVID-19

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2020-0426 ◽

2020 ◽

Vol 0 (0) ◽

Cited By ~ 1

Author(s):

Monica N. Naguib ◽

Jennifer K. Raymond ◽

Alaina P. Vidmar

Keyword(s):

Metabolic Acidosis ◽

Diabetic Ketoacidosis ◽

Pediatric Patients ◽

Systolic Function ◽

Hemodynamic Instability ◽

Case Presentation ◽

Onset Diabetes ◽

Potential Trigger ◽

Inflammatory Syndrome ◽

New Onset

AbstractIntroductionMultisystem inflammatory syndrome in children (MIS-C) is a unique clinical complication of SARS-CoV-2 infection observed in pediatric patients. COVID-19 is emerging as a potential trigger for the development of diabetes in children. Here, we report a patient presenting with MIS-C and new onset diabetes, and discuss the implication and clinical management of these concomitant conditions.Case presentationAn eight-year-old female presented with hyperglycemia, ketosis and metabolic acidosis consistent with diabetic ketoacidosis (DKA) in the setting of fever, rash, respiratory distress, hemodynamic instability, reduced systolic function with dilation of the left anterior descending artery, and positive SARS-CoV-2 antibodies suggestive of MIS-C.

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