Severe Pretreatment Cerebral Edema in Newly Diagnosed Type 1 Diabetes

Abstract

Introduction: Cerebral edema (CE) is a rare and dangerous complication of diabetic ketoacidosis. In typical cases, it may develop during several hours after the beginning of ketoacidosis therapy. Nevertheless, CE sometimes occurs before the start of any therapy - as for the patient in this report here. Case Report: We describe a 12-year-old girl with newly diagnosed type 1 diabetes, presenting with severe headache and disorientation. Diabetes-related symptoms were not reported by the family. Clinical investigation revealed signs of meningeal irritation and Kussmaul breathing. In the laboratory, severe ketoacidosis (pH 6.95) and hyperglycemia (blood glucose 20.9 mmmol/l) were found. Cranial computed tomography showed CE. The patient was treated with a very cautious fluid and insulin therapy and recovered within 3 days. MRI after recovery showed normal findings without residuals of CE. Conclusion: CE before any treatment of ketoacidosis is a very rare complication of type 1 diabetes. Early diagnosis and effective treatment are extremely important for the patient's outcome and prognosis.

Hypothalamic inflammation in metabolic disorders and aging

“…Similarly, hypothalamic neurons in diabetic mice are found to undergo degeneration [194], showing electron-dense cytoplasm, distension of rough endoplasmic reticulum, and swollen mitochondria [197,198]. Clinically, diabetic patients develop abnormal autoimmunity or inflammation [199] with a variety of functional and structural brain alterations, such as swelling and edema [200], with discrete brain activation patterns [201]. A brain MRI study of diabetic patients had an enlarged hypothalamus with thickened and compressed third ventricle.…”