Nicole S Glaser1, Sandra L Wootton-Gorges2, Isaac Kim2, Daniel J Tancredi3, James P Marcin3, Andrew Muir4, Nathan Kuppermann5. 1. Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, CA. Electronic address: nsglaser@ucdavis.edu. 2. Department of Radiology, School of Medicine, University of California Davis, Sacramento, CA. 3. Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, CA. 4. Department of Pediatrics, Emory University, Atlanta, GA. 5. Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, CA; Department of Emergency Medicine, School of Medicine, University of California Davis, Sacramento, CA.
Abstract
OBJECTIVE: To characterize regional differences in brain water distribution and content during diabetic ketoacidosis (DKA) in children and determine whether these differences correlate with regional vascular supply. STUDY DESIGN: We compared changes in brain water distribution and water content in different brain regions during DKA by analyzing magnetic resonance diffusion weighted imaging data collected during DKA and after recovery in 45 children (<18 years of age). We measured the apparent diffusion coefficient (ADC) of water in the frontal and occipital cortex, basal ganglia, thalamus, hippocampus, and medulla. Brain water content was also measured in a subset of patients. RESULTS: ADC values were elevated (suggesting vasogenic cerebral edema) in the frontal cortex, basal ganglia, thalamus, and hippocampus during DKA. In contrast, ADC values in the medulla and the occipital cortex were not increased during DKA, and ADC changes in the medulla tended to be negatively correlated with other regions. Regions supplied by the anterior/middle cerebral artery circulation had greater elevations in both ADC and brain water content during DKA compared with regions supplied by the posterior cerebral artery circulation. CONCLUSIONS: ADC changes during DKA in the brainstem contrast with those of other brain regions, and changes in both ADC and brain water content during DKA vary according to regional vascular supply. These data suggest that brainstem blood flow might possibly be reduced during DKA concurrent with hyperemia in other brain regions.
OBJECTIVE: To characterize regional differences in brain water distribution and content during diabetic ketoacidosis (DKA) in children and determine whether these differences correlate with regional vascular supply. STUDY DESIGN: We compared changes in brain water distribution and water content in different brain regions during DKA by analyzing magnetic resonance diffusion weighted imaging data collected during DKA and after recovery in 45 children (<18 years of age). We measured the apparent diffusion coefficient (ADC) of water in the frontal and occipital cortex, basal ganglia, thalamus, hippocampus, and medulla. Brain water content was also measured in a subset of patients. RESULTS: ADC values were elevated (suggesting vasogenic cerebral edema) in the frontal cortex, basal ganglia, thalamus, and hippocampus during DKA. In contrast, ADC values in the medulla and the occipital cortex were not increased during DKA, and ADC changes in the medulla tended to be negatively correlated with other regions. Regions supplied by the anterior/middle cerebral artery circulation had greater elevations in both ADC and brain water content during DKA compared with regions supplied by the posterior cerebral artery circulation. CONCLUSIONS: ADC changes during DKA in the brainstem contrast with those of other brain regions, and changes in both ADC and brain water content during DKA vary according to regional vascular supply. These data suggest that brainstem blood flow might possibly be reduced during DKA concurrent with hyperemia in other brain regions.
Authors: Nicole S Glaser; Sandra L Wootton-Gorges; Michael H Buonocore; Daniel J Tancredi; James P Marcin; Ryan Caltagirone; Yvonne Lee; Christopher Murphy; Nathan Kuppermann Journal: Pediatrics Date: 2012-12-10 Impact factor: 7.124
Authors: Joan S Roberts; Monica S Vavilala; Kenneth A Schenkman; Dennis Shaw; Lynn D Martin; Arthur M Lam Journal: Crit Care Med Date: 2006-08 Impact factor: 7.598
Authors: N Glaser; P Barnett; I McCaslin; D Nelson; J Trainor; J Louie; F Kaufman; K Quayle; M Roback; R Malley; N Kuppermann Journal: N Engl J Med Date: 2001-01-25 Impact factor: 91.245
Authors: Rachel J Skow; Christina M MacKay; Michael M Tymko; Christopher K Willie; Kurt J Smith; Philip N Ainslie; Trevor A Day Journal: Respir Physiol Neurobiol Date: 2013-06-14 Impact factor: 1.931
Authors: Nicole S Glaser; Sandra L Wootton-Gorges; James P Marcin; Michael H Buonocore; Joseph Dicarlo; E Kirk Neely; Patrick Barnes; Jenny Bottomly; Nathan Kuppermann Journal: J Pediatr Date: 2004-08 Impact factor: 4.406
Authors: Andrew DePiero; Nathan Kuppermann; Kathleen M Brown; Jeff E Schunk; Julie K McManemy; Arleta Rewers; Michael J Stoner; Leah Tzimenatos; Aris Garro; Sage R Myers; Kimberly S Quayle; Jennifer L Trainor; Maria Y Kwok; Lise E Nigrovic; Cody S Olsen; T Charles Casper; Simona Ghetti; Nicole S Glaser Journal: J Pediatr Date: 2020-05-06 Impact factor: 4.406
Authors: Nicole Glaser; Steven Chu; Benjamin Hung; Luis Fernandez; Heike Wulff; Daniel Tancredi; Martha E ODonnell Journal: BMJ Open Diabetes Res Care Date: 2020-12