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Coma with diffuse white matter hemorrhages in juvenile diabetic ketoacidosis.

Mahmud FH, Ramsay DA, Levin SD, Singh RN, Kotylak T, Fraser DD

Division of Pediatric Endocrinology, Children's Hospital of Western Ontario, 800 Commissioners Rd E, London, Ontario, Canada N6C 2V5. farid.mahmud@lhsc.on.ca

Cerebral edema is the most common neurologic complication of diabetic ketoacidosis in children. A minority of young patients with intracerebral crises in diabetic ketoacidosis present with cerebrovascular accidents. We report 2 adolescent patients with diabetic ketoacidosis who presented with coma and diffuse white matter hemorrhages in the absence of either cerebral edema or cerebrovascular accidents. These 2 cases illustrate a novel clinical and neuropathologic description of diffuse white matter hemorrhages, possibly related to a cytotoxic process as the underlying mechanism. These case descriptions emphasize that pediatric patients with diabetic ketoacidosis and coma can present with pathology not related to either cerebral edema or cerebrovascular accidents.

Published 6 December 2007 in Pediatrics, 120(6): e1540-6.
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