Aneurysmal Subarachnoid Hemorrhage Associated with Diabetic Ketoacidosis in a Patient with Insulin-Dependent Diabetes: An Autopsy Case Report

Introduction Diabetic ketoacidosis (DKA) is a well-known complication in diabetic patients, especially those who rely on insulin to maintain physiologic blood glucose levels, and allow for normal cellular uptake of glucose. While an uncommon cerebrovascular complication of DKA, there have been reported cases of subarachnoid hemorrhage (SAH) occurring in episodes of DKA. DKA is more prevalent in patients with insulin-dependent diabetes mellitus, particularly in younger patients under the age of 50. Methods A medicolegal autopsy was performed on a 19-year-old woman with a history of type 1 diabetes mellitus as well as prior episodes of DKA, who was found unresponsive in bed and did not survive resuscitation. Results The cause of death was found to be DKA on a background of elevated vitreous glucose and post-mortem serum β-hydroxybutyrate. Additionally, a mild recent SAH was found on post-mortem internal examination. Two aneurysms were identified in both the right ascending communicating artery (RACA) and right middle cerebral artery, and the SAH was found to originate from the RACA. There were other findings supportive of DKA, such as gastric erosions, pale kidney cortices, and fatty changes in the liver. Discussion DKA is a fatal complication of untreated diabetes mellitus, and the risk of mortality and morbidity increases with subsequent episodes. Diabetes can also predispose an individual to vasculopathies such as aneurysm formation, and subsequent SAH may be identified on post-mortem exam. While the SAH may not be the immediate cause of death, it is a rare finding in post-mortem examination of diabetic decedents, and the risk of aneurysm rupture may be the result of derangements such as increased intracranial pressure during DKA.