Category: Clinical Science
At the end of the session, participants will be able to:
- Describe fetal neuropathological findings associated with maternal diabetic ketoacidosis.
- Understand potential mechanisms of brain and spinal cord injury secondary to DKA.
COI Disclosure:
I do not have a relationship with a for-profit and/or a not-for-profit organization to disclose.
Presenter
Sumit Das – I am a clinical neuropathologist at the University of Alberta and Stollery Children’s Hospital, and Clinical Associate Professor at the University of Alberta Department of Laboratory Medicine and Pathology. I completed residency training in Neuropathology at Western University (London, ON) and in 2020 completed a mini-fellowship in Paediatric Neuropathology at BC Children’s Hospital.
While I practice in all aspects of neuropathology my subspecialty and academic interest is in paediatric and perinatal neuropathology, especially neurodevelopmental pathology. I was fortunate enough to have worked with Drs. P. Shannon and Y. Fisher on the production of our recent book “Atlas of Neurodevelopmental Pathology”. I also have an academic interest in neurodegenerative neuropathology and have also been part of some collaborative publications.
I currently serve as member of the Continuing Professional Development Committee, Scientific Planning Committee, and Board
member for the Canadian Association of Neuropathologists.
Sumit Das1,2, Monica Rodriguez3
1Department of Laboratory Medicine and Pathology, University of Alberta and Stollery Children’s Hospital, Edmonton, AB, Canada
2Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
3Laboratory Medicine and Pathology, Royal Alexandra Hospital, Edmonton, AB, Canada
Target Audience:
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Medical Students
CanMEDS:
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Fetal neuropathology of maternal diabetic ketoacidosis: A case report
Abstract
Although examples of brain and spinal cord abnormalities in fetal and pediatric patients of diabetic mothers are reported in the literature, neuropathologic validation still seems to be limited. Furthermore, to our knowledge there is no data in the English literature regarding brain and spinal cord pathology associated specifically with maternal diabetic ketoacidosis (DKA).We present here a case of termination of pregnancy for limb abnormalities and suspected agenesis of the sacrum, resulting in a stillborn fetus at 20 weeks and 6 days of gestation. The mother is a 36-year-old G7P4024 woman with a history of poorly controlled diabetes type 2 diabetes, managed with insulin and metformin. An episode of DKA was noted during approximately six weeks of gestation. Detailed obstetric ultrasound performed at 19 weeks of gestation reported abnormal fetal limbs. The sacral spine was also not well visualized, but there was suspicion of sacral agenesis. Neuropathologic examination revealed evidence of motor neuron loss in sections of spinal cord with reactive gliosis and activated microglia though not all levels were equally affected. There was also evidence of bilateral tegmental injury in the form of GFAP positive gliosis and shrunken midbrain and pontine tegmentum. Periventricular foci of CD68 positive microglia were also present, thought to be consistent with prior hypoxic-ischemic injury. We believe this case may provide initial insight into fetal neuropathological changes resulting from DKA as well as possible pathogenesis. Our case also highlights the importance of extensive spinal cord sampling to rule our parenchymal injury.