Diabetic ketoacidosis without cerebral edema linked to neurocognitive changes

From Clinical Endocrinology News, 2 January 2014:

MELBOURNE – Diabetic ketoacidosis was associated with swelling of white brain matter and shrinkage of gray matter, and the degree of change was associated with neurocognitive outcomes up to 6 months after the event, based on a study of children who were newly diagnosed with type 1 diabetes and did not have cerebral edema.

In a prospective cohort study of children newly diagnosed with type 1 diabetes, 36 patients presented with and 59 without diabetic ketoacidosis. Researchers performed magnetic resonance imaging (T1 weighted, diffusion tensor imaging, and fractional anisotropy) and a battery of psychometric tests at the time of diagnosis, then again at 1 week, 4 weeks, and 6 months after diagnosis in both groups.

Although there was no net change in brain volume, total gray matter volume was reduced and total cortical white matter volume was increased on day 1 in the diabetic ketoacidosis group.

Compared with those without ketoacidosis, children with ketoacidosis had lower levels of a marker of neuronal density, lower activity in the frontal gray matter and basal ganglia on day 1, and lower mental state scores on days 1 and 5.

“Swelling had resolved by the end of the first week but was associated with neurocognitive outcomes at 6 months. So even though the brain looked normal, [those with ketoacidosis at diagnosis] were still performing less well on neuropsychological testing, especially in terms of long-term memory,” said Dr. Fergus Cameron, head of diabetes services at the Royal Children’s Hospital, Melbourne. Read more.

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