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Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus

Cerebral oedema is the most common neurological complication of diabetic ketoacidosis (DKA). However, ischaemic and haemorrhagic brain injury has been reported infrequently. A 10-year old girl who was previously well presented with severe DKA. She was tachycardic with poor peripheral perfusion but n...

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Main Authors: Mohd Nor, Noor Shafina, Fong, Choong Yi, Rahmat, Kartini, Lee, Vanessa Wan Mun, Anuar Zaini, Azriyanti, Jalaludin, Muhammad Yazid
Format: Article
Published: Touch Medical Media 2018
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R Medicine
Online Access:http://eprints.um.edu.my/21107/
https://doi.org/10.17925/EE.2018.14.1.59
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spelling my.um.eprints.211072021-02-08T07:30:32Z http://eprints.um.edu.my/21107/ Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus Mohd Nor, Noor Shafina Fong, Choong Yi Rahmat, Kartini Lee, Vanessa Wan Mun Anuar Zaini, Azriyanti Jalaludin, Muhammad Yazid R Medicine Cerebral oedema is the most common neurological complication of diabetic ketoacidosis (DKA). However, ischaemic and haemorrhagic brain injury has been reported infrequently. A 10-year old girl who was previously well presented with severe DKA. She was tachycardic with poor peripheral perfusion but normotensive. However, two fast boluses totalling 40 ml/kg normal saline were given. She was transferred to another hospital where she was intubated due to drowsiness. Rehydration fluid (maintenance and 48-hour correction for 7.5% dehydration) was started followed by insulin infusion. She was extubated within 24 hours of admission. Her ketosis resolved soon after and subcutaneous insulin was started. However, about 48 hours after admission, her Glasgow Coma Scale score dropped to 11/15 (E4M5V2) with expressive aphasia and upper motor neuron signs. One dose of mannitol was given. Her symptoms improved gradually and at 26-month follow-up she had a near-complete recovery with only minimal left lower limb weakness. Serial magnetic resonance imaging brain scans showed vascular ischaemic injury at the frontal-parietal watershed regions with haemorrhagic transformation. This case reiterates the importance of monitoring the neurological status of patient's with DKA closely for possible neurological complications including an ischaemic and haemorrhagic stroke. Touch Medical Media 2018 Article PeerReviewed Mohd Nor, Noor Shafina and Fong, Choong Yi and Rahmat, Kartini and Lee, Vanessa Wan Mun and Anuar Zaini, Azriyanti and Jalaludin, Muhammad Yazid (2018) Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus. European Endocrinology, 14 (1). pp. 59-61. ISSN 1758-3772 https://doi.org/10.17925/EE.2018.14.1.59 doi:10.17925/EE.2018.14.1.59
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic R Medicine
spellingShingle R Medicine
Mohd Nor, Noor Shafina
Fong, Choong Yi
Rahmat, Kartini
Lee, Vanessa Wan Mun
Anuar Zaini, Azriyanti
Jalaludin, Muhammad Yazid
Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus
description Cerebral oedema is the most common neurological complication of diabetic ketoacidosis (DKA). However, ischaemic and haemorrhagic brain injury has been reported infrequently. A 10-year old girl who was previously well presented with severe DKA. She was tachycardic with poor peripheral perfusion but normotensive. However, two fast boluses totalling 40 ml/kg normal saline were given. She was transferred to another hospital where she was intubated due to drowsiness. Rehydration fluid (maintenance and 48-hour correction for 7.5% dehydration) was started followed by insulin infusion. She was extubated within 24 hours of admission. Her ketosis resolved soon after and subcutaneous insulin was started. However, about 48 hours after admission, her Glasgow Coma Scale score dropped to 11/15 (E4M5V2) with expressive aphasia and upper motor neuron signs. One dose of mannitol was given. Her symptoms improved gradually and at 26-month follow-up she had a near-complete recovery with only minimal left lower limb weakness. Serial magnetic resonance imaging brain scans showed vascular ischaemic injury at the frontal-parietal watershed regions with haemorrhagic transformation. This case reiterates the importance of monitoring the neurological status of patient's with DKA closely for possible neurological complications including an ischaemic and haemorrhagic stroke.
format Article
author Mohd Nor, Noor Shafina
Fong, Choong Yi
Rahmat, Kartini
Lee, Vanessa Wan Mun
Anuar Zaini, Azriyanti
Jalaludin, Muhammad Yazid
author_facet Mohd Nor, Noor Shafina
Fong, Choong Yi
Rahmat, Kartini
Lee, Vanessa Wan Mun
Anuar Zaini, Azriyanti
Jalaludin, Muhammad Yazid
author_sort Mohd Nor, Noor Shafina
title Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus
title_short Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus
title_full Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus
title_fullStr Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus
title_full_unstemmed Ischaemic Haemorrhagic Stroke in a Child with New Onset Type 1 Diabetes Mellitus
title_sort ischaemic haemorrhagic stroke in a child with new onset type 1 diabetes mellitus
publisher Touch Medical Media
publishDate 2018
url http://eprints.um.edu.my/21107/
https://doi.org/10.17925/EE.2018.14.1.59
_version_ 1691733428737671168
score 13.211869

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