MULTIPLE CEREBRAL HEMATOMAS AND PERIPHERAL-NERVE PALSIES ASSOCIATED WITH A CASE OF JUVENILE DIABETIC-KETOACIDOSIS

A 15-year-old girl presented de novo in diabetic ketoacidosis having b een comatose for 24 h (day 1). A CT scan and lumbar puncture performed on admission were normal and her conscious level slowly improved over several days. On day 7 she had central neurological signs of bilatera l knee clonus and an extensor plantar response. In addition, she had d eveloped lower motor neurological signs of an ulnar nerve palsy of the left forearm, and ulnar, median, and radial nerve palsies of the righ t forearm. Magnetic resonance imaging (MRI), performed on day 12, show ed multiple small cerebral haematomata with appearances at least sever al days of age. The scattered lesions were localized particularly to t he parieto-occipital region, with sparing of the basal ganglia and wit hout cerebral oedema, a novel feature not previously described in juve nile ketoacidosis. Four months later there was minimal residual disabi lity of her right arm. The clinical findings together with the MRI ima ges suggested that the peripheral nerve and central lesions were tempo rally related, suggesting a common aetiology. However, it is likely th at MRI showed cerebral lesions which may have been missed by the conve ntional CT scanning performed initially.