Bilateral Posterior Circulation Stroke in a Child with Type 1 Diabetes Mellitus

A 10-year old girl presented with acute onset fever, head-ache, recurrent seizures, and encephalopathy for 2 days. She was diagnosed to have type-1 diabetes mellitus at 8 years of age and managed with subcutaneous insulin therapy. She had a history of recurrent episodes of hypo-glycemia and hyperglycemia due to poor compliance. On examination, she was encephalopathic (Glasgow coma scale score of 11), hypertensive (blood pressure [BP]: 132/80 mm Hg), had normal fundus and anthropometric parameters. Her pupils were dilated with preserved reac-tion and she had right sided hemiparesis and left sided ptosis. Initial investigations showed severe acidosis (pH 7.15), ketosis, and hyperglycemia (26.8 mmol/L). A diag-nosis of severe diabetic ketoacidosis with raised intra cranial pressure (ICP) was considered. Her glycosylated hemoglobin was 9.8% re fl ecting poor glycemic control. She was managed with isotonic fl uid, insulin therapy, multiple antiepileptic drugs, mechanical ventilation, and antiraised ICP measures for cerebral edema. Following recovery from