Diabetic ketoacidosis (DKA) induced cerebral edema complicating small chronic subdural hematoma/hygroma/ at Zewuditu memorial hospital: a case report

Abstract

Background While both DKA & CSDH/subdural hygroma/ are known to cause significant morbidity and mortality, there is no a study that shows the role & effect of DKA on CSDH/subdural hygroma/ & vice versa to authors’ best knowledge; hence this work will show how important relation does exist between DKA & CSDH/ hygroma. Case summary This study highlights the diagnostic & management challenges seen for a case of a 44 years old female black Ethiopian woman admitted with a diagnosis of newly diagnosed type 1 DM with DKA + small CSDH/subdural hygroma/ after she presented with sever global headache and a 3 month history of lost to her work. She needed burrhole & evacuation for complete clinical improvement besides DKA’s medical treatment. Conclusion DKA induced cerebral edema on the CSDH/subdural hematoma/ can have a role in altering any of the parameters (except the thickness of CSDH) for surgical indication of patients with a diagnosis of both CSDH +DM with DKA. Hence, the treating physicians should be vigilant of different parameters that suggests tight brain &/ cerebral edema (including midline shift, the status of cisterns, fissures & sulci) and should not be deceived of the thickness of the CSDH/subdural hygroma/alone; especially when there is a disproportionately tight brain for the degree of collection. Whether DKA induced cerebral edema causes a subdural hygroma is unknown and needs further study.

Predisposing Factors of Cerebral Edema in Pediatric Diabetic Ketoacidosis: A Systematic Review

“…ONSD, which indicates an increase in intracranial pressure, can be measured by bedside ultrasound, shows many changes during treatment of children with DKA, and reaches its highest values in the middle of treatment (47). In Hansen et al's study on ONSD sonography, it was found that subtle changes in ONSD may occur despite the absence of clinical signs of cerebral edema, but it is unclear to what extent these changes reflect actual changes in intracranial pressure (45). It is useful for monitoring the effectiveness of DKA treatment in children and for the prevention of cerebral edema and other acute complications of type 1 diabetes (42).…”

“…Predicting pediatrics at risk for cerebral edema is challenging (45). Although some degree of cerebral edema is present in most DKA patients, symptomatic cerebral edema is uncommon and is primarily diagnosed in 0.5 to 1% of children (38).…”