Regional Brain Water Content and Distribution During Diabetic Ketoacidosis.
OBJECTIVE
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 DESIGN
We 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.


RESULTS
ADC 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.


CONCLUSIONS
ADC 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.
['Glaser|Nicole S|NS|', 'Wootton-Gorges|Sandra L|SL|', 'Kim|Isaac|I|', 'Tancredi|Daniel J|DJ|', 'Marcin|James P|JP|', 'Muir|Andrew|A|', 'Kuppermann|Nathan|N|']
D000293:Adolescent D001834:Body Water D001921:Brain D002648:Child D016883:Diabetic Ketoacidosis D038524:Diffusion Magnetic Resonance Imaging D006801:Humans
diabetes diabetic ketoacidosis cerebral edema brain injury magnetic resonance imaging