Stroke may not only trigger diabetic ketoacidosis (DKA), but diabetic ketoacidosis can trigger stroke. The diagnosis may be challenging in a pediatric patient for whom stroke is unexpected

Patient selection: diabetic ketoacidosis (DKA)


Frequency of stroke: rare


Risk factors:

(1) hypercoagulability

(2) atherosclerosis

(3) hypertension

(4) dehydration

(5) substance abuse


The onset may be during the acute phase or several days after treatment.


Clinical features may include:

(1) altered level of consciousness, stupor or coma

(2) neurologic deficit consistent with stroke (aphasia, unilateral weakness, etc)

(3) headache

(4) seizure

(5) change in behavior

(6) urinary incontinence

(7) difficulty swallowing


The diagnosis depends on demonstration of stroke on head CT and/or MRI.


Differential diagnosis:

(1) stroke prior to onset of DKA

(2) cerebral edema

(3) extrapontine myelinolysis

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