Cerebral edema associated with diabetic ketoacidosis: Two case reports

Abstract

Background: Diabetic ketoacidosis (DKA) is associated with a high mortality rate, especially if cerebral edema develops during the disease course. It is rarer and more severe in adults than in children. We present cases of two patients with cerebral edema-related DKA.

Case presentation: The first patient was a 38-year-old man with diabetes mellitus who presented with DKA-related disturbed consciousness. Although glycemic correction was performed slowly, he showed pupil dilation 11 h later. He underwent emergency ventricular drainage, but died of cerebral herniation. The second patient was a 25-year-old woman who presented with impaired consciousness secondary to DKA. Head computed tomography showed subarachnoid hemorrhage and cerebral edema. No related intraoperative findings were observed; it was concluded that the first computed tomography scan revealed pseudo-subarachnoid hemorrhage.

Conclusion: Diabetic ketoacidosis-related cerebral edema develops despite treatment according to guidelines and is difficult to predict. Therefore, adult patients should be treated cautiously during DKA management.

Keywords: DKA; cerebral edema; consciousness; diabetes; diabetic ketoacidosis.

FIGURE 1

Case 1: A 38‐year‐old man presented with unconsciousness. (A) A brain computed tomography (CT) scan obtained on admission shows no brain edema. (B) A brain CT on admission shows no compression to the midbrain. (C) Eleven hours after admission, bilateral pupil dilation was noted. The CT scan shows prominent cerebral edema. (D) Change in serum glucose and insulin dosage.

FIGURE 2

Case 2: A 25‐year‐old woman presented with impaired consciousness. (A, B) A brain computed tomography (CT) scan obtained on admission showing narrowed ventricles and an area of high density in the basal cistern, suggesting subarachnoid hemorrhage. (C) A 3D CT angiogram on admission shows a right middle cerebral artery aneurysm (yellow arrowhead). (D, E) Postoperative findings. Intraoperative brain edema was severe, and external decompression was carried out. (F) Change in serum glucose and insulin dosage.