Home Pediatric stroke as the presenting symptom of new-onset type 1 diabetes mellitus without DKA: case report and literature review
Article
Licensed
Unlicensed Requires Authentication

Pediatric stroke as the presenting symptom of new-onset type 1 diabetes mellitus without DKA: case report and literature review

  • Sonum A. Bharill , Janel D. Hunter , Elizabeth T. Walsh , David F. Crudo and Cathrine Constantacos ORCID logo EMAIL logo
Published/Copyright: July 19, 2019
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 32 Issue 9

Abstract

Background

Stroke and other neurologic complications are rare in pediatric type 1 diabetes mellitus (T1DM) without severe diabetic ketoacidosis (DKA) or poor glycemic control.

Case presentation

A previously healthy, 10-year-old female presented with acute thalamic stroke, non-acidotic new T1DM diagnosis and negative hypercoagulopathy workup. She received routine insulin therapy and aspirin, and returned to neurologic baseline within a year without stroke recurrence.

Conclusions

The contribution of non-acidotic hyperglycemia to stroke risk is better described in adults. Even though unable to prove causality, this case should at least raise awareness of the possible association of pediatric new-onset diabetes and stroke for optimal outcomes.

Keywords: new onset diabetes; pediatric; stroke
Corresponding author: Cathrine Constantacos, MD, FAAP, Assistant Professor, Pediatrics, Section of Endocrinology, Wake Forest University Baptist Health, Department of Pediatrics, 1 Medical Center Boulevard, Winston Salem, NC 27157, USA

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved the submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

  6. Informed consent: Informed consent was obtained from all individuals included in this case presentation.

References

1. Group SfDiYS, Liese AD, D’Agostino Jr RB, Hamman RF, Kilgo PD, et al. The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study. Pediatrics 2006;118:1510–8.10.1542/peds.2006-0690Search in Google Scholar PubMed

2. Merger SR, Leslie RD, Boehm BO. The broad clinical phenotype of type 1 diabetes at presentation. Diabet Med 2013;30:170–8.10.1111/dme.12048Search in Google Scholar PubMed

3. Dabelea D, Rewers A, Stafford JM, Standiford DA, Lawrence JM, et al. Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for Diabetes in Youth Study. Pediatrics 2014;133:e938–45.10.1542/peds.2013-2795Search in Google Scholar PubMed PubMed Central

4. Mulder L, Onur O, Kleis L, Borders H, Cemeroglu AP. Atypical neurologic presentations of new onset type 1 diabetes mellitus in pediatric age group: a report of five unusual cases and review of the literature. J Pediatr Endocrinol Metab 2014;27:749–56.10.1515/jpem-2013-0312Search in Google Scholar PubMed

5. Foster JR, Morrison G, Fraser DD. Diabetic ketoacidosis-associated stroke in children and youth. Stroke Res Treat 2011;2011:219706.10.4061/2011/219706Search in Google Scholar PubMed PubMed Central

6. Lin JJ, Lin KL, Wang HS, Wong AM, Hsia SH. Occult infarct with acute hemorrhagic stroke in juvenile diabetic ketoacidosis. Brain Dev 2008;30:91–3.10.1016/j.braindev.2007.06.001Search in Google Scholar PubMed

7. Ho J, Mah JK, Hill MD, Pacaud D. Pediatric stroke associated with new onset type 1 diabetes mellitus: case reports and review of the literature. Pediatr Diabetes 2006;7:116–21.10.1111/j.1399-543X.2006.00151.xSearch in Google Scholar PubMed

8. Ergul A, Li W, Elgebaly MM, Bruno A, Fagan SC. Hyperglycemia, diabetes and stroke: focus on the cerebrovasculature. Vascul Pharmacol 2009;51:44–9.10.1016/j.vph.2009.02.004Search in Google Scholar PubMed PubMed Central

9. Carl GF, Hoffman WH, Passmore GG, Truemper EJ, Lightsey AL, et al. Diabetic ketoacidosis promotes a prothrombotic state. Endocr Res 2003;29:73–82.10.1081/ERC-120018678Search in Google Scholar PubMed

10. Snarska KK, Bachorzewska-Gajewska H, Kapica-Topczewska K, Drozdowski W, Chorazy M, et al. Hyperglycemia and diabetes have different impacts on outcome of ischemic and hemorrhagic stroke. Arch Med Sci 2017;13:100–8.10.5114/aoms.2016.61009Search in Google Scholar PubMed PubMed Central

11. Mijajlovic MD, Aleksic VM, Sternic NM, Mirkovic MM, Bornstein NM. Role of prediabetes in stroke. Neuropsychiatr Dis Treat 2017;13:259–67.10.2147/NDT.S128807Search in Google Scholar PubMed PubMed Central

12. Sarrafzadegan N, Gharipour M, Sadeghi M, Nezafati P, Talaie M, et al. Metabolic Syndrome and the risk of ischemic stroke. J Stroke Cerebrovasc Dis 2017;26:286–94.10.1016/j.jstrokecerebrovasdis.2016.09.019Search in Google Scholar PubMed

13. Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 2001;32:2426–32.10.1161/hs1001.096194Search in Google Scholar PubMed

14. Lawrence RD. Renal threshold for glucose: normal and in diabetics. Br Med J 1940;1:766–8.10.1136/bmj.1.4140.766Search in Google Scholar PubMed PubMed Central

Received: 2019-05-17
Accepted: 2019-06-09
Published Online: 2019-07-19
Published in Print: 2019-09-25

© 2019 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Original Articles
  3. Association of the 3′UTR polymorphism (rs11665896) in the FGF21 gene with metabolic status and nutrient intake in children with obesity
  4. Future glycemic control of children diagnosed with type 1 diabetes mellitus at toddler and preschool/school age
  5. Children with type 1 diabetes of early age at onset – immune and metabolic phenotypes
  6. Determination of cerebral edema with serial measurement of optic nerve sheath diameter during treatment in children with diabetic ketoacidosis: a longitudinal study
  7. Association between inflammation, oxidative stress, vitamin D, copper and zinc with pre-obesity and obesity in school children from the city of Podgorica, Montenegro
  8. Phenotypic diversity and correlation with the genotypes of pseudohypoaldosteronism type 1
  9. Start low, go slowly – mental abnormalities in young prolactinoma patients under cabergoline therapy
  10. Primary ovarian insufficiency in an adolescent population: clinical phenotype and diagnostic approach
  11. Novel combined insulin-like 3 variations of a single nucleotide in cryptorchidism
  12. Evaluation of the abdominopelvic region using MRI in patients with primary amenorrhea
  13. Benefits of aerobic training in girls with precocious puberty: involvement of CRP and cortisol
  14. The relationship between the olfactory bulb and precocious puberty: from the nose to the pituitary
  15. Short Communication
  16. Experience with intramuscular glucagon for infants with early neonatal hypoglycemia
  17. Case Reports
  18. A novel GATA6 variant in a boy with neonatal diabetes and diaphragmatic hernia: a familial case with a review of the literature
  19. Nephrogenic diabetes insipidus in a 15-year-old Hispanic female with a novel AQP2 mutation
  20. Pediatric stroke as the presenting symptom of new-onset type 1 diabetes mellitus without DKA: case report and literature review
  21. Panhypopituitarism from neurosarcoidosis in an adolescent: case report and literature review
https://doi.org/10.1515/jpem-2019-0222
Keywords for this article
new onset diabetes; pediatric; stroke

Articles in the same Issue

  1. Frontmatter
  2. Original Articles
  3. Association of the 3′UTR polymorphism (rs11665896) in the FGF21 gene with metabolic status and nutrient intake in children with obesity
  4. Future glycemic control of children diagnosed with type 1 diabetes mellitus at toddler and preschool/school age
  5. Children with type 1 diabetes of early age at onset – immune and metabolic phenotypes
  6. Determination of cerebral edema with serial measurement of optic nerve sheath diameter during treatment in children with diabetic ketoacidosis: a longitudinal study
  7. Association between inflammation, oxidative stress, vitamin D, copper and zinc with pre-obesity and obesity in school children from the city of Podgorica, Montenegro
  8. Phenotypic diversity and correlation with the genotypes of pseudohypoaldosteronism type 1
  9. Start low, go slowly – mental abnormalities in young prolactinoma patients under cabergoline therapy
  10. Primary ovarian insufficiency in an adolescent population: clinical phenotype and diagnostic approach
  11. Novel combined insulin-like 3 variations of a single nucleotide in cryptorchidism
  12. Evaluation of the abdominopelvic region using MRI in patients with primary amenorrhea
  13. Benefits of aerobic training in girls with precocious puberty: involvement of CRP and cortisol
  14. The relationship between the olfactory bulb and precocious puberty: from the nose to the pituitary
  15. Short Communication
  16. Experience with intramuscular glucagon for infants with early neonatal hypoglycemia
  17. Case Reports
  18. A novel GATA6 variant in a boy with neonatal diabetes and diaphragmatic hernia: a familial case with a review of the literature
  19. Nephrogenic diabetes insipidus in a 15-year-old Hispanic female with a novel AQP2 mutation
  20. Pediatric stroke as the presenting symptom of new-onset type 1 diabetes mellitus without DKA: case report and literature review
  21. Panhypopituitarism from neurosarcoidosis in an adolescent: case report and literature review
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 23.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/jpem-2019-0222/html?lang=en
Scroll to top button