Bilateral cerebral infarction in diabetic ketoacidosis and bilateral internal carotid artery occlusion: A case report and review of literature

doi:10.12998/wjcc.v9.i15.3787

中山醫學大學機構典藏 CSMUIR > 中山醫學大學研究成果 > 其他文獻 > Item 310902500/24128

Please use this identifier to cite or link to this item: https://ir.csmu.edu.tw:8080/ir/handle/310902500/24128

Title:	Bilateral cerebral infarction in diabetic ketoacidosis and bilateral internal carotid artery occlusion: A case report and review of literature
Authors:	Chen, YC;Tsai, SJ
Keywords:	Type 1 diabetes mellitus;Diabetic ketoacidosis;Bilateral internal carotid artery occlusion;Cerebral infarction;Case report
Date:	2021
Issue Date:	2022-08-05T10:43:34Z (UTC)
Publisher:	BAISHIDENG PUBLISHING GROUP INC
ISSN:	2307-8960
Abstract:	BACKGROUND Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes mellitus (T1DM). Very rarely does DKA lead to cerebral edema, and it is even rarer for it to result in cerebral infarction. Bilateral internal carotid artery occlusion (BICAO) is also rare and can cause fatal stroke. Moreover, case reports about acute cerebral infarction throughout both internal carotid arteries with simultaneous BICAO are very scarce. In this study, we present a patient with BICAO, T1DM, hypertension, and hyperlipidemia, who had a catastrophic bilateral cerebral infarction after a DKA episode. We briefly introduce BICAO and the mechanisms by which DKA results in cerebral infarction. CASE SUMMARY A 41-year-old woman presented with ischemic stroke that took place 3 mo prior over the left corona radiata, bilateral frontal lobe, and parietal lobe with right hemiplegia and Broca's aphasia. She had a history of hypertension for 5 years, hyperlipidemia for 4 years, hyperthyroidism for 3 years, and T1DM for 31 years. The first brain magnetic resonance imaging not only revealed the aforementioned ischemic lesions but also bilateral internal carotid artery occlusion. She was admitted to our ward for rehabilitation due to prior stroke sequalae. DKA took place on hospital day 2. On hospital day 6, she had a new massive infarction over the bilateral anterior cerebral artery and middle cerebral artery territory. After weeks of aggressive treatment, she remained in a coma and on mechanical ventilation due to respiratory failure. After discussion with her family, compassionate extubation was performed on hospital day 29 and she died. CONCLUSION DKA can lead to cerebral infarction due to several mechanisms. In people with existing BICAO and several stroke risk factors such as hypertension, T1DM, hyperlipidemia, DKA has the potential to cause more serious ischemic strokes.
URI:	http://dx.doi.org/10.12998/wjcc.v9.i15.3787 https://www.webofscience.com/wos/woscc/full-record/WOS:000652200000036 https://ir.csmu.edu.tw:8080/handle/310902500/24128
Relation:	WORLD JOURNAL OF CLINICAL CASES ,2021 ,v9 ,issue15
Appears in Collections:	[中山醫學大學研究成果] 其他文獻

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