title: Hydrocephalus requiring urgent external ventricular drainage in a patient with diabetic ketoacidosis and cerebral edema: case report.
abstract: OBJECTIVE
  Neurological deterioration, typically attributed to cerebral edema, is a rare but life-threatening complication in the treatment of diabetic ketoacidosis (DKA). We report the case of a child with DKA who became comatose but demonstrated acute obstructive hydrocephalus, instead of cerebral edema.
  
  
  METHODS
  An 11-year-old male patient presented with new-onset insulin-dependent diabetes mellitus and DKA. He was initially responsive but, after several hours of treatment, became unresponsive, with dilated pupils and decerebrate posturing. Cranial computed tomographic scanning demonstrated obstructive hydrocephalus resulting from focal cerebellar and brain stem edema.
  
  
  METHODS
  The patient was initially managed with medical treatment but ultimately required urgent ventricular drainage to arrest a progressive herniation syndrome. To our knowledge, this report describes only the second such case reported and the first requiring urgent ventriculostomy.
  
  
  CONCLUSIONS
  These observations emphasize the importance of recognizing hydrocephalus as a potentially reversible cause of coma in DKA and of initiating prompt neurosurgical intervention, if warranted.
authors.affiliation: Neurosurgical Service, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: E N
authors.initials: EN
authors.lastname: Eskandar
authors.forename: S J
authors.initials: SJ
authors.lastname: Weller
authors.forename: D M
authors.initials: DM
authors.lastname: Frim
mesh_terms: D001929:Brain Edema / Q000209:etiology*; D002648:Child; D003128:Coma / Q000209:etiology; D016883:Diabetic Ketoacidosis / Q000150:complications*; D004630:Emergencies; D004677:Encephalocele / Q000209:etiology* / Q000601:surgery; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D008297:Male; D014696:Ventriculostomy