Insights into the acute cerebral metabolic changes associated with childhood diabetes

Abstract

Aims
Type 1 diabetes is a prevalent chronic disease in childhood with the com-
monest single cause of death being cerebral oedema in the context of diabetic
ketoacidosis (DKA). The nature of the alterations in cerebral metabolism that
may result in vulnerability to neuronal injury remains unknown. The aim of this
study was to analyse the magnetic resonance imaging (MRI) and magnetic
resonance spectroscopy (MRS) brain data from eight children with diabetes
following acute presentation with hyperglycaemia with or without ketoacidosis,
to determine the nature and timing of any alterations in cerebral structure and
metabolism.
Methods
This study used MRI and MRS to investigate regional cerebral abnor-
malities in a small series of diabetic patients with and without DKA. Changes
were compared with the clinical and biochemical features of the patients studied.
Results
Our small series of patients all demonstrated abnormal signal changes
in the frontal region on fluid attenuated inversion recovery (FLAIR) MR imag-
ing, suggestive of oedema, and spectroscopic abnormalities of increased taurine,
myoinositol and glucose levels. The MR abnormalities varied in severity but did
not correlate with any clinical or biochemical parameters.
Conclusions
These changes indicate that many diabetic children, particularly
at presentation, may have alterations in cerebral metabolism with implications
for the pathogenesis and treatment of the cerebral complications of DKA. In addi-
tion, our findings suggest that increased taurine may be one of the important
differentiating factors in the response of the brain of diabetic children to DKA
that may reflect an increase in their vulnerability to cerebral oedema compared
with diabetic adults.