Progressive decrease in N-acetylaspartate/Creatine ratio in a teenager with type 1 diabetes and repeated episodes of ketoacidosis without clinically apparent cerebral edema: Evidence for permanent brain injury

Abstract

Recent data suggest that DKA may contribute to cognitive impairment in children with type 1 DM. We measured the NAA/Cr ratio in a teenager during and following 2 separate episodes of DKA without clinically apparent cerebral edema. The NAA/Cr ratio decreased during DKA and improved following recovery. However, the NAA/Cr value was lower after the second episode of DKA (1.76) than after the first (1.97). These findings provide support for the hypothesis that neuronal injury may result from DKA.

Fig 1.

TR/TE 1500/144 ms single-voxel spectroscopy of the right basal ganglia in a 14-year-old boy during 2 episodes of DKA 2 months apart. The first episode of DKA is shown on the top 2 spectra, and second episode, on the bottom 2 spectra. The first of each pair of spectra was obtained during DKA treatment, 9–12 hours after beginning therapy. The second of the pair was obtained after recovery. During the acute DKA episode, the NAA/Cr ratio is decreased compared with the postrecovery spectra. In addition, the NAA/Cr ratio is lower (1.76) after recovery from the second episode of DKA compared with the postrecovery spectra from the first episode (1.97). This suggests a degree of permanent neuronal dysfunction or loss resulting from DKA.