title: Stroke as the presenting feature of new onset diabetes in a young man.
abstract: A 34-year-old man presented to a hospital with a 7-day history of nausea, vertigo, ataxia and frontal headache. Examination revealed ipsilateral cerebellar signs. CT of the brain demonstrated left cerebellar hypodensity suggestive of ischaemic stroke or space occupying lesion. Full blood count showed a markedly raised haemoglobin (219 g/L) and haematocrit (0.56). Admission urinalysis was performed but the results not reviewed. Owing to patient deterioration, an arterial blood gas was performed. This showed profound metabolic acidosis. Repeat urinalysis was positive for glucose and ketones. MRI of the brain confirmed ischaemic stroke. The underlying cause of this was hyperviscosity secondary to relative polycythaemia, resulting from undiagnosed diabetic ketoacidosis as a first presentation of diabetes. This case report highlights ischaemic stroke as an unusual presenting feature of diabetic ketoacidosis. Notably, the underlying diagnosis of diabetic ketoacidosis was initially missed, thereby emphasising the importance of performing an admission urinalysis and acting on the results.
authors: Department of Dermatology, NHS Lothian, Edinburgh, UK.
authors: Ruth
authors: R
authors: Jones
authors: Department of Endocrinology, NHS Lothian, Edinburgh, UK.
authors: Emily
authors: E
authors: McMurray
authors: Intensive Care Unit, NHS Lothian, Edinburgh, UK.
authors: Oliver
authors: O
authors: Robinson
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology*; D003920:Diabetes Mellitus / Q000175:diagnosis; D016883:Diabetic Ketoacidosis / Q000150:complications / Q000175:diagnosis* / Q000652:urine; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007659:Ketones / Q000652:urine; D008279:Magnetic Resonance Imaging; D008297:Male; D011086:Polycythemia / Q000209:etiology; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000652:urine; D014783:Viscosity
chemical_list: D007659:Ketones; D005947:Glucose