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Child's Nervous System
Published in: Child's Nervous System 4/2011

01-04-2011 | Case Report

Life-saving decompressive craniectomy for diffuse cerebral edema during an episode of new-onset diabetic ketoacidosis

Case report and review of the literature

Authors: Ha Son Nguyen, James D. Callahan, Aaron A. Cohen-Gadol

Published in: Child's Nervous System | Issue 4/2011

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Abstract

Purpose

Diabetic ketoacidosis (DKA), a well-known complication of diabetes mellitus, is associated with severe diffuse cerebral edema leading to brain herniation and death. Survival from an episode of symptomatic cerebral edema has been associated with debilitating neurological sequelae, including motor deficits, visual impairment, memory loss, seizures, and persistent vegetative states. A review of the literature reveals scant information regarding the potential surgical options for these cases. The authors present their case in which they used a craniectomy to treat this life-threatening condition.

Methods

After reportedly suffering nausea and vomiting, a 12-year-old male presented to the emergency room with lethargy and was diagnosed with acute DKA. After appropriate treatment, the patient became comatose. A CT scan revealed diffuse cerebral edema. To decrease intracranial pressure and prevent further progression of brain herniation, a bifrontal decompressive craniectomy with duraplasty was performed.

Results

The patient’s neurological function gradually improved, and he returned to school and his regular activities with only minimal cognitive deficits.

Conclusion

Given the high mortality and morbidity associated with DKA-related edema, we believe decompressive craniectomy should be considered for malignant cerebral edema and herniation syndrome.
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Metadata
Title
Life-saving decompressive craniectomy for diffuse cerebral edema during an episode of new-onset diabetic ketoacidosis
Case report and review of the literature
Authors
Ha Son Nguyen
James D. Callahan
Aaron A. Cohen-Gadol
Publication date
01-04-2011
Publisher
Springer-Verlag
Published in
Child's Nervous System / Issue 4/2011
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-010-1285-9

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