title: Insights into the acute cerebral metabolic changes associated with childhood diabetes.
abstract: OBJECTIVE
  Type 1 diabetes is a prevalent chronic disease in childhood with the commonest single cause of death being cerebral oedema in the context of diabetic ketoacidosis (DKA). The nature of the alterations in cerebral metabolism that may result in vulnerability to neuronal injury remains unknown. The aim of this study was to analyse the magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) brain data from eight children with diabetes following acute presentation with hyperglycaemia with or without ketoacidosis, to determine the nature and timing of any alterations in cerebral structure and metabolism.
  
  
  METHODS
  This study used MRI and MRS to investigate regional cerebral abnormalities in a small series of diabetic patients with and without DKA. Changes were compared with the clinical and biochemical features of the patients studied.
  
  
  RESULTS
  Our small series of patients all demonstrated abnormal signal changes in the frontal region on fluid attenuated inversion recovery (FLAIR) MR imaging, suggestive of oedema, and spectroscopic abnormalities of increased taurine, myoinositol and glucose levels. The MR abnormalities varied in severity but did not correlate with any clinical or biochemical parameters.
  
  
  CONCLUSIONS
  These changes indicate that many diabetic children, particularly at presentation, may have alterations in cerebral metabolism with implications for the pathogenesis and treatment of the cerebral complications of DKA. In addition, our findings suggest that increased taurine may be one of the important differentiating factors in the response of the brain of diabetic children to DKA that may reflect an increase in their vulnerability to cerebral oedema compared with diabetic adults.
authors.affiliation: Centre for Hormone Research, Melbourne, Australia. fergus.cameron@rch.org.au
authors.forename: F J
authors.initials: FJ
authors.lastname: Cameron
authors.forename: M J
authors.initials: MJ
authors.lastname: Kean
authors.forename: R M
authors.initials: RM
authors.lastname: Wellard
authors.forename: G A
authors.initials: GA
authors.lastname: Werther
authors.forename: J J
authors.initials: JJ
authors.lastname: Neil
authors.forename: T E
authors.initials: TE
authors.lastname: Inder
mesh_terms: D000293:Adolescent; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism*; D001929:Brain Edema / Q000517:prevention & control; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D011859:Radiography; D013654:Taurine / Q000378:metabolism
chemical_list: D013654:Taurine