Cerebral Small Vessel Disease in Children and Adolescents with Type 1 Diabetes Presenting with Diabetic Ketoacidosis during COVID-19 Era

Abstract

Abstract Aim Cerebrovascular insult (CVI) is a known and significant morbidity of diabetic ketoacidosis (DKA); yet, its prevalence is underestimated. Untreated cerebral hypoperfusion in DKA may lead to cerebral injury, arterial ischemic stroke, cerebral venous thrombosis, and hemorrhagic stroke. This study assesses the cerebral perfusion status among children and adolescents with DKA during and after the resolution of DKA. Methodology Forty children and adolescents with type 1 diabetes mellitus (T1DM) presenting with DKA were assessed for severity of DKA, diabetes-duration, insulin therapy, Rappaport coma/ Near coma scale, Rancho los amigos levels of cognitive functioning scale, glycated-hemoglobin (HbA1c), D-dimer, INR and brain magnetic resonance imaging (MRI) during DKA and repeated neuro cognitive scoring, laboratory and MRI after resolution of the DKA. Results The mean age of the children and adolescents with T1DM presenting with DKA was 11.40 ± 2.82 years; their median diabetes-duration was 3 year; their mean HbA1c was 13.54 ± 2%. There was significant increase in platelet (P = 0.005), D-dimer (P < 0.001), Creatinine (P < 0.001) and Pulse wave velocity (P = 0.004) during attack of DKA while there was significance decrease in Apparent diffusion coefficient (P < 0.001). There was 30% of children and adolescents with T1DM had ischemic MRI changes during DKA. In children and adolescent with ischemic changes there was significant increase in severity of DKA (P = 0.003), HbA1c (P = 0.016), INR (P = 0.002), D-dimer (P < 0.001), Creatinine (P = 0.003). Conclusion Significant cerebral hypoperfusion occur during the DKA which is correlated with the DKA severity and D-dimer levels.