title: Regional Brain Water Content and Distribution During Diabetic Ketoacidosis.
abstract: To characterize regional differences in brain water distribution and content during diabetic ketoacidosis (DKA) in children and determine whether these differences correlate with regional vascular supply.
  
  
  
  We compared changes in brain water distribution and water content in different brain regions during DKA by analyzing magnetic resonance diffusion weighted imaging data collected during DKA and after recovery in 45 children (<18 years of age). We measured the apparent diffusion coefficient (ADC) of water in the frontal and occipital cortex, basal ganglia, thalamus, hippocampus, and medulla. Brain water content was also measured in a subset of patients.
  
  
  
  ADC values were elevated (suggesting vasogenic cerebral edema) in the frontal cortex, basal ganglia, thalamus, and hippocampus during DKA. In contrast, ADC values in the medulla and the occipital cortex were not increased during DKA, and ADC changes in the medulla tended to be negatively correlated with other regions. Regions supplied by the anterior/middle cerebral artery circulation had greater elevations in both ADC and brain water content during DKA compared with regions supplied by the posterior cerebral artery circulation.
  
  
  
  ADC changes during DKA in the brainstem contrast with those of other brain regions, and changes in both ADC and brain water content during DKA vary according to regional vascular supply. These data suggest that brainstem blood flow might possibly be reduced during DKA concurrent with hyperemia in other brain regions.
authors.affiliation: Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, CA. Electronic address: nsglaser@ucdavis.edu.
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Glaser
authors.affiliation: Department of Radiology, School of Medicine, University of California Davis, Sacramento, CA.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wootton-Gorges
authors.affiliation: Department of Radiology, School of Medicine, University of California Davis, Sacramento, CA.
authors.forename: Isaac
authors.initials: I
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, CA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tancredi
authors.affiliation: Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, CA.
authors.forename: James P
authors.initials: JP
authors.lastname: Marcin
authors.affiliation: Department of Pediatrics, Emory University, Atlanta, GA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Muir
authors.affiliation: Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, CA; Department of Emergency Medicine, School of Medicine, University of California Davis, Sacramento, CA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D000293:Adolescent; D001834:Body Water / Q000000981:diagnostic imaging / Q000378:metabolism*; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000378:metabolism*; D002648:Child; D016883:Diabetic Ketoacidosis / Q000378:metabolism*; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans
keywords: brain injury; cerebral edema; diabetes; diabetic ketoacidosis; magnetic resonance imaging