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Imaging of the brain in children with type I diabetes mellitus

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Abstract

Type 1 diabetes mellitus (DM) affects about 1 in 500 children and can cause damage to multiple organ systems. In recent years, growing attention has been given to the effects of type 1 DM on the brain. In this article we review important imaging features of the brain in children with type 1 DM, including (1) imaging the child in diabetic ketoacidosis and the child with hypoglycemia, (2) syndromes associated with type 1 DM, and (3) long-term effects of type 1 DM on brain structure.

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References

  1. Styne DM, Glaser NS (1998) Endocrine disorders: diabetes mellitus. In: Behrman RE, Kliegman R (eds) Nelson essentials of pediatrics, 3rd edn, W.B. Saunders, Philadelphia, pp 679–687

    Google Scholar 

  2. Sperling MA (1984) Diabetic ketoacidosis. Pediatr Clin North Am 31:591–610

    PubMed  CAS  Google Scholar 

  3. Glaser N (2006) New perspectives on the pathogenesis of cerebral edema complicating diabetic ketoacidosis in children. Pediatr Endocrinol Rev 4:379–386

    Google Scholar 

  4. Edge J, Hawkins M, Winter D et al (2001) The risk and outcome of cerebral oedema developing during diabetic ketoacidosis. Arch Dis Child 85:16–22

    Article  PubMed  CAS  Google Scholar 

  5. Dunger DB, Sperling MA, Acerini CL et al (2004) ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents. Arch Dis Child 89:188–194

    Article  PubMed  CAS  Google Scholar 

  6. Rosenbloom AL (1990) Intracerebral crises during treatment of diabetic ketoacidosis. Diabetes Care 13:22–33

    Article  PubMed  CAS  Google Scholar 

  7. Glaser N, Barnett P, McCaslin I et al (2001) Risk factors for cerebral edema in children with diabetic ketoacidosis. N Engl J Med 344:264–269

    Article  PubMed  CAS  Google Scholar 

  8. Carlotti AP, Bohn D, Halperin ML (2003) Importance of timing of risk factors for cerebral oedema during therapy for diabetic ketoacidosis. Arch Dis Child 88:170–173

    Article  PubMed  CAS  Google Scholar 

  9. Lawrence SE, Cummings EA, Gaboury I et al (2005) Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis. J Pediatr 146:688–692

    Article  PubMed  Google Scholar 

  10. Bohn D, Daneman D (2002) Diabetic ketoacidosis and cerebral edema. Curr Opin Pediatr 14:287–291

    Article  PubMed  Google Scholar 

  11. Levitsky LL (2004) Symptomatic cerebral edema in diabetic ketoacidosis: the mechanism is clarified but still far from clear. J Pediatr 145:149–150

    Article  PubMed  Google Scholar 

  12. Glaser N (2001) Cerebral edema in children with diabetic ketoacidosis. Curr Diab Rep 1:41–46

    Article  PubMed  CAS  Google Scholar 

  13. Muir AB, Quisling RG, Yang MCK et al (2004) Cerebral edema in childhood diabetic ketoacidosis. Diabetes Care 27:1541–1546

    Article  PubMed  Google Scholar 

  14. Osborn AG (1994) Diagnostic neuroradiology. Mosby Year Book, St. Louis, pp 230–231

    Google Scholar 

  15. Rogers B, Sills I, Cohen M et al (1990) Diabetic ketoacidosis: neurologic collapse during treatment followed by severe developmental morbidity. Clin Pediatr (Phila) 29:451–456

    Article  CAS  Google Scholar 

  16. Hoffman WH, Casanova MF, Bauza JA et al (1999) Computer analysis of magnetic resonance imaging of the brain in children and adolescents after treatment of diabetic ketoacidosis. J Diabetes Complications 13:176–181

    Article  PubMed  CAS  Google Scholar 

  17. Cameron FJ, Kean MJ, Wellard RM et al (2005) Insights into the acute cerebral metabolic changes associated with childhood diabetes. Diabetes Med 22:648–653

    Article  CAS  Google Scholar 

  18. Bonkowsky JL, Filloux FM (2003) Extrapontine myelinolysis in a pediatric case of diabetic ketoacidosis and cerebral edema. J Child Neurol 18:144–147

    Article  PubMed  Google Scholar 

  19. Glaser NS, Wootton-Gorges SL, Buonocore MH et al (2006) Frequency of sub-clinical cerebral edema in children with diabetic ketoacidosis. Pediatr Diabetes 7:75–80

    Article  PubMed  Google Scholar 

  20. Krane EJ, Rockoff MA, Wallman JK et al (1985) Subclinical brain swelling in children during treatment of diabetic ketoacidosis. N Eng J Med 312:1147–1151

    Article  CAS  Google Scholar 

  21. Hoffman WH, Steinhart CM, El Gammal T et al (1988) Cranial CT in children and adolescents with diabetic ketoacidosis. AJNR 9:733–739

    PubMed  CAS  Google Scholar 

  22. Durr JA, Hoffman WH, Sklar AH et al (1992) Correlates of brain edema in uncontrolled IDDM. Diabetes 41:627–632

    Article  PubMed  CAS  Google Scholar 

  23. Glaser NS, Wootton-Gorges SL, Marcin JP et al (2004) Mechanism of cerebral edema in children with diabetic ketoacidosis. J Pediatr 145:164–171

    Article  PubMed  Google Scholar 

  24. Figueroa RE, Hoffman WH, Momin Z et al (2005) Study of subclinical cerebral edema in diabetic ketoacidosis by magnetic resonance imaging T2 relaxometry and apparent diffusion coefficient maps. Endocr Res 31:345–355

    Article  PubMed  Google Scholar 

  25. Isales C, Min L, Hoffman W (1999) Acetoacetate and B-hydroxybutyrate differentially regulate endothelin-1 and vascular endothelial growth factor in mouse brain microvascular endothelial cells. J Diabetes Complications 13:91–97

    Article  PubMed  CAS  Google Scholar 

  26. Edge J (2000) Cerebral oedema during treatment of diabetic ketoacidosis: are we any nearer to finding a cause? Diabetes Metab Res Rev 16:316–324

    Article  PubMed  CAS  Google Scholar 

  27. Brubaker LM, Smith JK, Lee YZ et al (2005) Hemodynamic and permeability changes in posterior reversible encephalopathy syndrome measured by dynamic susceptibility perfusion-weighted MR imaging. AJNR 26:825–830

    PubMed  Google Scholar 

  28. Silver SM, Clark EC, Schroeder BM et al (1997) Pathogenesis of cerebral edema after treatment of diabetic ketoacidosis. Kidney Int 51:1237–1244

    Article  PubMed  CAS  Google Scholar 

  29. Wootton-Gorges SL, Buonocore MH, Kuppermann N et al (2005) Detection of cerebral b-hydroxybutyrate, acetoacetate, and lactate on proton MR spectroscopy in children with diabetic ketoacidosis. AJNR 26:1286–1291

    PubMed  Google Scholar 

  30. Wootton-Gorges SL, Buonocore MH, Kuppermann N et al (2007) Cerebral proton magnetic resonance spectroscopy in children with diabetic ketoacidosis. AJNR 28:895–899

    PubMed  CAS  Google Scholar 

  31. Saunders DE, Howe FA, van den Boogaart A et al (1995) Continuing ischaemic damage after acute middle cerebral artery infarction in humans demonstrated by short-echo proton spectroscopy. Stroke 26:1007–1013

    PubMed  CAS  Google Scholar 

  32. Saunders DE (2000) MR spectroscopy in stroke. Br Med Bull 56:334–345

    Article  PubMed  CAS  Google Scholar 

  33. Bizzi A, Ulug AM, Crawford TO et al (2001) Quantitative proton MR spectroscopic imaging in acute disseminated encephalomyelitis. AJNR 22:1125–1130

    PubMed  CAS  Google Scholar 

  34. Nakamura S, Yoshinari M, Wakisaka M et al (2000) Ketoacidosis accompanied by epileptic seizures in a patient with diabetes mellitus and mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS). Diabetes Metab 26:407–410

    PubMed  CAS  Google Scholar 

  35. Möller-Hartmann W, Herminghaus S, Krings T et al (2002) Clinical application of proton magnetic resonance spectroscopy in the diagnosis of intracranial mass lesions. Neuroradiology 44:371–381

    Article  PubMed  Google Scholar 

  36. Gasparovic C, Rosenberg GA, Wallace JA et al (2001) Magnetic resonance lipid signals in rat brain after experimental stroke correlate with neutral lipid accumulation. Neurosci Lett 301:87–90

    Article  PubMed  CAS  Google Scholar 

  37. Auer RN (1986) Progress review: hypoglycemic brain damage. Stroke 17:699–708

    PubMed  CAS  Google Scholar 

  38. Dolinak D, Smith C, Graham DI (2000) Hypoglycemia is a cause of axonal injury. Neuropathol Appl Neurobiol 26:448–453

    Article  PubMed  CAS  Google Scholar 

  39. Jung SL, Kim BS, Lee KS et al (2005) Magnetic resonance imaging and diffusion-weighted imaging changes after hypoglycemic coma. J Neuroimaging 15:193–196

    Article  PubMed  CAS  Google Scholar 

  40. Mori F, Nishie M, Houzen H et al (2006) Hypoglycemic encephalopathy with extensive lesions in the cerebral white matter. Neuropathology 26:147–152

    Article  PubMed  Google Scholar 

  41. Lo L, Tan AC, Umapathi T et al (2006) Diffusion-weighted MR imaging in early diagnosis and prognosis of hypoglycemia. AJNR 27:1222–1224

    PubMed  CAS  Google Scholar 

  42. Bottcher J, Kunze A, Kurrat C et al (2005) Localized reversible reduction of apparent diffusion coefficient in transient hypoglycemia-induced hemiparesis. Stroke 36:e20–e22

    Article  PubMed  CAS  Google Scholar 

  43. Aoki T, Sato T, Hasegawa K et al (2004) Reversible hyperintensity lesion on diffusion-weighted MRI in hypoglycemic coma. Neurology 63:392–393

    PubMed  CAS  Google Scholar 

  44. Maekawa S, Aibiki M, Kikuchi K et al (2006) Time-related changes in reversible MRI findings after prolonged hypoglycemia. Clin Neurol Neurosurg 108:511–513

    Article  PubMed  Google Scholar 

  45. Chan R, Erbay S, Oljeski S et al (2003) Hypoglycemia and diffusion-weighted imaging. J Comput Assist Tomogr 27:420–423

    Article  PubMed  Google Scholar 

  46. Wolfram D, Wagener HP (1938) Diabetes mellitus and simple optic atrophy among siblings: report of four cases. Proc Staff Meet Mayo Clin 13:715–718

    Google Scholar 

  47. Page MM, Asmal AC, Edwards CR (1976) Recessive inheritance of diabetes: the syndrome of diabetes insipidus, diabetes mellitus, optic atrophy and deafness. Q J Med 179:505–520

    Google Scholar 

  48. Scolding NJ, Kellar-Wood HF, Shaw C et al (1996) Wolfram syndrome: hereditary diabetes mellitus with brainstem and optic atrophy. Ann Neurol 39:352–360

    Article  PubMed  CAS  Google Scholar 

  49. Blasi C, Pierelli F, Rispoli E et al (1986) Wolfram syndrome: a clinical, diagnostic and interpretative contribution. Diabetes Care 9:521–528

    Article  PubMed  CAS  Google Scholar 

  50. Karasik A, O’Hara C, Srikanta S et al (1989) Genetically programmed selective B-cell loss in diabetic subjects with Wolfram’s syndrome. Diabetes Care 12:135–138

    Article  PubMed  CAS  Google Scholar 

  51. Polymeropoulos MH, Swift RG, Swift M (1994) Linkage of the genes for Wolfram syndrome to markers on the short arm of chromosome 4. Nat Genet 8:95–97

    Article  PubMed  CAS  Google Scholar 

  52. Yang MS, Chen CCC, Cheng YY et al (2005) Imaging characteristics of familial Wolfram syndrome. J Formos Med Assoc 104:129–132

    PubMed  Google Scholar 

  53. Rando TA, Horton JC, Layzer RB (1992) Wolfram syndrome: evidence of a diffuse neurodegenerative disease by magnetic resonance imaging. Neurology 42:1220–1224

    PubMed  CAS  Google Scholar 

  54. Senee V, Vatterm KM, Delepine M et al (2004) Wolcott-Rallison syndrome. Clinical, genetic and functional study of EIF2AK3 mutations and suggestion of genetic heterogenicity. Diabetes 53:1876–1883

    Article  PubMed  CAS  Google Scholar 

  55. de Wit MC, de Coo IF, Julier C et al (2006) Microcephaly and simplified gyral pattern of the brain associated with early onset insulin-dependent diabetes mellitus. Neurogenetics 7:259–263

    Article  PubMed  Google Scholar 

  56. Takeshima T, Nakashima K (2005) MIDD and MELAS: a clinical spectrum. Intern Med 44:276–277

    Article  PubMed  Google Scholar 

  57. Kobayashi Z, Tsunemi T, Maike H et al (2005) A mother and a child with maternally inherited diabetes and deafness (MIDD) showing atrophy of the cerebrum, cerebellum and brainstem on magnetic resonance imaging (MRI). Intern Med 44:328–331

    Article  PubMed  Google Scholar 

  58. Onishi H, Inoue K, Osaka H et al (1992) MELAS associated with diabetes mellitus and point mutation in mitochondrial DNA. No To Shinkei 44:259–264

    PubMed  CAS  Google Scholar 

  59. Yang CY, Lam HC, Lee HC et al (1995) MELAS syndrome associated with diabetes mellitus and hyperthyroidism: a case report from Taiwan. Clin Endocrinol (Oxf) 43:235–239

    CAS  Google Scholar 

  60. Drouet A, Guilloton L, Godinot C et al (2000) Mitochondrial diabetes complicated by or associated with “MELAS” syndrome? Rev Neurol 156:892–895

    PubMed  CAS  Google Scholar 

  61. Allard JC, Tilak S, Carter AP (1988) CT and MR of MELAS syndrome. AJNR 9:1234–1238

    PubMed  CAS  Google Scholar 

  62. Barkovich AH, Good W, Koch TK et al (1993) Mitochondrial disorders: analysis of their clinical and imaging characteristics. AJNR 14:1119–1137

    PubMed  CAS  Google Scholar 

  63. Castillo M, Kwock L, Green C (1995) MELAS syndrome: imaging and proton MR spectroscopic findings. AJNR 16:233–239

    PubMed  CAS  Google Scholar 

  64. Biessels GJ (1999) Cerebral complications of diabetes: clinical findings and pathogenetic mechanisms. Neth J Med 54:35–45

    Article  PubMed  CAS  Google Scholar 

  65. McCarthy A, Lindgren S, Mengeling M et al (2002) Effects of diabetes on learning in children. Pediatrics 109:E9

    Article  PubMed  Google Scholar 

  66. Franceschi M, Cecchetto R, Minnicucci F et al (1984) Cognitive processes in insulin-dependent diabetes. Diabetes Care 7:228–231

    Article  PubMed  CAS  Google Scholar 

  67. Widom B, Simonson D (1990) Glycemic control and neuropsychologic function during hypoglycemia in patients with insulin-dependent diabetes mellitus. Ann Intern Med 112:904–912

    PubMed  CAS  Google Scholar 

  68. Rovet JF, Ehrlich RM, Hoppe M (1987) Intellectual deficits associated with early onset of insulin-dependent diabetes mellitus in children. Diabetes Care 10:510–515

    Article  PubMed  CAS  Google Scholar 

  69. Ferguson SC, Blane A, Wardlaw J et al (2005) Influence of an early-onset age of type 1 diabetes on cerebral structure and cognitive function. Diabetes Care 28:1431–1437

    Article  PubMed  Google Scholar 

  70. Araki Y, Nomura M, Tanaka H et al (1994) MRI of the brain in diabetes mellitus. Neuroradiology 36:101–103

    Article  PubMed  CAS  Google Scholar 

  71. Lunetta M, Damanti AR, Fabbri G et al (1994) Evidence by magnetic resonance imaging of cerebral alterations of atrophy type in young insulin-dependent diabetic patients. J Endocrinol Invest 17:241–245

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, UC Davis Children’s Hospital, University of California, Davis Medical Center, Sacramento, CA, USA

    Sandra L. Wootton-Gorges

  2. Department of Pediatrics, UC Davis Children’s Hospital, University of California, Davis Medical Center, Sacramento, CA, USA

    Nicole S. Glaser

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  1. Sandra L. Wootton-Gorges
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  2. Nicole S. Glaser
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Correspondence to Sandra L. Wootton-Gorges.

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Wootton-Gorges, S.L., Glaser, N.S. Imaging of the brain in children with type I diabetes mellitus. Pediatr Radiol 37, 863–869 (2007). https://doi.org/10.1007/s00247-007-0536-8

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  • DOI: https://doi.org/10.1007/s00247-007-0536-8

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