Regional Brain Water Content and Distribution During Diabetic Ketoacidosis

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• 作者：Nicole S. Glaser ; MD¹ ; ^{nsglaser@ucdavis.edu} ; Sandra L. Wootton-Gorges ; MD² ; Isaac Kim ; MD² ; Daniel J. Tancredi ; PhD¹ ; James P. Marcin ; MD ; MPH¹ ; Andrew Muir ; MD⁴ ; Nathan Kuppermann ; MD ; MPH¹ ; ³
• 关键词：diabetes ; diabetic ketoacidosis ; brain injury ; cerebral edema ; magnetic resonance imaging
• 刊名：The Journal of Pediatrics
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：180
• 期：Complete
• 页码：170-176
• 全文大小：230 K
• 卷排序：180

文摘

To characterize regional differences in brain water distribution and content during diabetic ketoacidosis (DKA) in children and determine whether these differences correlate with regional vascular supply.Study designWe compared changes in brain water distribution and water content in different brain regions during DKA by analyzing magnetic resonance diffusion weighted imaging data collected during DKA and after recovery in 45 children (<18 years of age). We measured the apparent diffusion coefficient (ADC) of water in the frontal and occipital cortex, basal ganglia, thalamus, hippocampus, and medulla. Brain water content was also measured in a subset of patients.ResultsADC values were elevated (suggesting vasogenic cerebral edema) in the frontal cortex, basal ganglia, thalamus, and hippocampus during DKA. In contrast, ADC values in the medulla and the occipital cortex were not increased during DKA, and ADC changes in the medulla tended to be negatively correlated with other regions. Regions supplied by the anterior/middle cerebral artery circulation had greater elevations in both ADC and brain water content during DKA compared with regions supplied by the posterior cerebral artery circulation.ConclusionsADC changes during DKA in the brainstem contrast with those of other brain regions, and changes in both ADC and brain water content during DKA vary according to regional vascular supply. These data suggest that brainstem blood flow might possibly be reduced during DKA concurrent with hyperemia in other brain regions.