Pediatric stroke associated with new onset type 1 diabetes mellitus: case reports and review of the literature

Ho, Josephine; Mah, Jean K.; Hill, Michael D; Pacaud, Danièle

doi:10.1111/j.1399-543x.2006.00151.x

Cited by 22 publications

(19 citation statements)

References 44 publications

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“…It is likely that the oxidative stress induced by hyperglycemia and ketosis [31] contributes to this inflammatory reaction and results in diffuse vascular injury. Evidence of vascular endothelial injury can be seen in pretreatment subclinical CE [1], pulmonary interstitial edema [2, 23, 24, 32], disseminated intravascular coagulation (DIC) [13, 16, 33, 34], and elevated levels of thrombomodulin [35]. …”

Section: Pathogenesis Of Ischemic Strokementioning

confidence: 99%

Diabetic Ketoacidosis-Associated Stroke in Children and Youth

Foster

Morrison

Fraser

2011

Stroke Research and Treatment

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Diabetic ketoacidosis (DKA) is a state of severe insulin deficiency, either absolute or relative, resulting in hyperglycemia and ketonemia. Although possibly underappreciated, up to 10% of cases of intracerebral complications associated with an episode of DKA, and/or its treatment, in children and youth are due to hemorrhage or ischemic brain infarction. Systemic inflammation is present in DKA, with resultant vascular endothelial perturbation that may result in coagulopathy and increased hemorrhagic risk. Thrombotic risk during DKA is elevated by abnormalities in coagulation factors, platelet activation, blood volume and flow, and vascular reactivity. DKA-associated cerebral edema may also predispose to ischemic injury and hemorrhage, though cases of stroke without concomitant cerebral edema have been identified. We review the current literature regarding the pathogenesis of stroke during an episode of DKA in children and youth.

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Section: Pathogenesis Of Ischemic Strokementioning

confidence: 99%

Diabetic Ketoacidosis-Associated Stroke in Children and Youth

Foster

Morrison

Fraser

2011

Stroke Research and Treatment

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“…Taking into consideration of Virchow's triad (changes in the vessel wall endothelium, stasis and hypercoagulable state), all the three predisposing factors for vascular thrombosis are met in patients with DKA. Previous studies on DVT in children with DKA attribute DVT to femoral vein catheterization [6] or, in one case [4], to the presence of a previously unknown thrombophilia, while other studies failed to identify any specific coagulation abnormalities [3,5,7]. In our case, dehydration, hyperviscosity and patient immobilization due to DKA and its management, together with the presence of congenital PS deficiency, could explain the multifactorial development of thrombosis.…”

Section: Discussionmentioning

confidence: 64%

“…However, the incidence of thromboembolic complications is low, suggesting that children with an inherited predisposition to thrombosis must have an additional risk factor before thrombosis occurs [16]. Most previous reports on DVT in children with DKA failed to identify any specific coagulation abnormalities [3,5,7]. There is only one previous case report on a child with DKA and thrombosis with coexistent factor V Leiden deficiency [4].…”

Section: Introductionmentioning

confidence: 99%

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Deep Vein Thrombosis and Pulmonary Embolism in a Child with Diabetic Ketoacidosis and Protein S Deficiency: A Case Report

et al. 2013

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Introduction: Diabetic ketoacidosis (DKA) is considered a hypercoagulable state, which may be exacerbated in patients with thrombophilia and lead to thrombosis. Case Report: We report on a 5.5-year-old boy, who was admitted to the pediatric department with DKA due to newly diagnosed type 1 diabetes. Low-grade fever was reported for 6 days prior to admission and continued during DKA management, with negative septic screening. After DKA management, the child developed symptoms of iliofemoral deep vein thrombosis (DVT). A family history of protein S (PS) deficiency was revealed. He was initially treated intravenously with antibiotics and unfractionated heparin, which, after 2 days, was switched to low-molecular-weight heparin and vitamin K antagonist (VKA) due to poor anticoagulant response. On the 6th day of anticoagulant treatment, the patient presented with pulmonary embolism (PE); he continued with VKA and antibiotics, with significant clinical improvement. Prolonged fever was attributed to DVT and PE. The patient was discharged on oral anticoagulants and insulin. Conclusion: We report on a child with congenital PS deficiency and DKA who developed DVT and PE despite anticoagulant treatment. It is important in children presenting with DKA to seek thoroughly for a medical history of thrombophilia and to start early thromboprophylaxis in such cases in order to prevent a possible thrombosis.

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“…Diabetic ketoacidosis (DKA) is associated with the risk of neurologic complications; children with DKA may be affected mostly by cerebral edema and less frequently by arterial or venous strokes [1]. Our cases represent three different acute brain events: diffuse vasogenic edema, venous thrombosis, and multifocal cytotoxic edema.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Accidents in Pediatric Diabetic Ketoacidosis: Different Complications and Different Evolutions

Mozzillo

D’Amico²,

Fattorusso³

et al. 2015

Horm Res Paediatr

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Diabetic ketoacidosis (DKA) may be associated with neurologic complications: the most common is cerebral edema while the risk of venous and arterial stroke is rare. There is a pathogenetic link between DKA, hypercoagulability and stroke, whose risk is underestimated by clinicians. Our cases present a wide spectrum of cerebral accidents during DKA, the first one being diffuse cerebral edema, the second one venous stroke after 5 days of DKA resolution, while the third one multifocal edema suspected to be extrapontine myelinolysis although without electrolyte imbalance. Our cases suggest that DKA requires very accurate treatment, particularly at an early age, and it can be complicated by cerebral accidents even with appropriate medical care.

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Pediatric stroke associated with new onset type 1 diabetes mellitus: case reports and review of the literature

Cited by 22 publications

References 44 publications

Diabetic Ketoacidosis-Associated Stroke in Children and Youth

Diabetic Ketoacidosis-Associated Stroke in Children and Youth

Deep Vein Thrombosis and Pulmonary Embolism in a Child with Diabetic Ketoacidosis and Protein S Deficiency: A Case Report

Cerebral Accidents in Pediatric Diabetic Ketoacidosis: Different Complications and Different Evolutions

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