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Insights into the acute cerebral metabolic changes associated with childhood diabetes

By Fergus J. Cameron, Michael J. Kean, R. Mark Wellard, George A. Werther, Jeffrey J. Neil and Terrie E. Inder

Abstract

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

Topics: 111403 Paediatrics, 110900 NEUROSCIENCES, 110199 Medical Biochemistry and Metabolomics not elsewhere classified, 060101 Analytical Biochemistry, 060000 BIOLOGICAL SCIENCES, 110302 Clinical Chemistry (diagnostics), 100400 MEDICAL BIOTECHNOLOGY, 100499 Medical Biotechnology not elsewhere classified, 111603 Systems Physiology, 060105 Cell Neurochemistry, 119900 OTHER MEDICAL AND HEALTH SCIENCES, 060104 Cell Metabolism, 100499 Medical Biotechnology not elsewhere classified, 060603 Animal Physiology - Systems, 111601 Cell Physiology, 110306 Endocrinology, 060600 PHYSIOLOGY, 060602 Animal Physiology - Cell, 110300 CLINICAL SCIENCES, 110100 MEDICAL BIOCHEMISTRY AND METABOLOMICS, 110903 Central Nervous System, 110000 MEDICAL AND HEALTH SCIENCES, 111600 MEDICAL PHYSIOLOGY, 110902 Cellular Nervous System, 110904 Neurology and Neuromuscular Diseases, brain, childhood, magnetic resonance, metabolism, MRS
Publisher: Blackwell Publishing
Year: 2005
DOI identifier: 10.1111/j.1464-5491.2005.01453.x
OAI identifier: oai:eprints.qut.edu.au:8911
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