Cerebral Proton Magnetic Resonance Spectroscopy in Children with Diabetic Ketoacidosis

Subclinical cerebral edema occurs in many, if not most, children with diabetic ketoacidosis (DKA) and may be an indicator of subtle brain injury. Brain ratios of N-acetylaspartate (NAA) to creatine (Cr), measured by proton MR spectroscopy, decrease with neuronal injury or dysfunction. We hypothesize...

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Bibliographic Details
Published in:American Journal of Neuroradiology 2007-05, Vol.28 (5), p.895-899
Main Authors: Wootton-Gorges, S.L, Buonocore, M.H, Kuppermann, N, Marcin, J.P, Barnes, P.D, Neely, E.K, DiCarlo, J, McCarthy, T, Glaser, N.S
Format: Article
Language:English
Subjects:
Adolescent
Adult and adolescent clinical studies
Aspartic Acid - analogs & derivatives
Aspartic Acid - metabolism
Biological and medical sciences
Brain - metabolism
Brain Edema - diagnosis
Brain Edema - etiology
Brain Edema - metabolism
Cardiovascular system
Child
Choline - metabolism
Consciousness Disorders - diagnosis
Consciousness Disorders - etiology
Consciousness Disorders - metabolism
Creatine - metabolism
Diabetic Ketoacidosis - complications
Diabetic Ketoacidosis - metabolism
Glasgow Coma Scale
Humans
Investigative techniques, diagnostic techniques (general aspects)
Magnetic Resonance Spectroscopy
Medical sciences
Miscellaneous
Mood disorders
Nervous system
Pediatrics
Protons
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Radiodiagnosis. Nmr imagery. Nmr spectrometry
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Summary:Subclinical cerebral edema occurs in many, if not most, children with diabetic ketoacidosis (DKA) and may be an indicator of subtle brain injury. Brain ratios of N-acetylaspartate (NAA) to creatine (Cr), measured by proton MR spectroscopy, decrease with neuronal injury or dysfunction. We hypothesized that brain NAA/Cr ratios may be decreased in children in DKA, indicating subtle neuronal injury. Twenty-nine children with DKA underwent cerebral proton MR spectroscopy during DKA treatment (2-12 hours after initiating therapy) and after recovery from the episode (72 hours or more after the initiation of therapy). We measured peak heights of NAA, Cr, and choline (Cho) in 3 locations within the brain: the occipital gray matter, the basal ganglia, and periaqueductal gray matter. These regions were identified in previous studies as areas at greater risk for neurologic injury in DKA-related cerebral edema. We calculated the ratios of NAA/Cr and Cho/Cr and compared these ratios during the acute illness and recovery periods. In the basal ganglia, the ratio of NAA/Cr was significantly lower during DKA treatment compared with that after recovery (1.68 +/- 0.24 versus 1.86 +/- 0.28, P
ISSN:0195-6108
1936-959X
1432-1920