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Diabetic Amyotrophy Recovery

Diabetic Proximal Neuropathy, The Muscle Wasting From Diabetes

Diabetic Proximal Neuropathy, The Muscle Wasting From Diabetes

Diabetic proximal neuropathy, or amyotrophy, is the muscle weakness and wasting caused by years of high blood sugar. But you can prevent and even reverse it. Diabetic proximal neuropathy is only one of the diabetic neuropathies. Like all the others it is the result of long-term high blood sugar. It is not as well known as the numbness and tingling of fingers and toes that nearly every type 2 diabetic deals with from the beginning of diabetes. That's because not everyone with type 2 diabetes has the symptoms of muscle wasting and weakness of diabetic proximal neuropathy. Also called diabetic amyotrophy (myo- for muscles and -trophy for breaking down), this neuropathy arrives after years and years of too much glucose in your blood. Diabetic peripheral neuropathy starts with pain in the muscles of your thighs, hips, buttocks or legs. In rare cases it also affects your shoulders, too. But wherever it shows up, the pain is usually on only one side, or on one side more than the other. If the cause of the muscle wasting is diabetic nerve disease, it is always in older adults who have had diabetes for a while. Type 2 diabetes has been damaging the blood vessels that supply nerves with oxygen, destroying the nerve pathways slowly over time. The effect is weakness in your legs. You cannot stand up from a chair without help. Your knee and ankle reflexes become weaker and disappear. That's one reason doctors check your reflexes at each physical. They gently tap your knee and ankle joints with a small hammer as they measure your responses. If diabetic proximal neuropathy continues the result is quadriparesis, the medical term for extreme weakness in the arms and legs. That's why it is called muscle wasting. There are other causes for muscle wasting that need to be ruled out, such as Continue reading >>

Diabetic Amyotrophy In An Adolescent Responsive To Intravenous Immunoglobulin

Diabetic Amyotrophy In An Adolescent Responsive To Intravenous Immunoglobulin

Diabetic amyotrophy in an adolescent responsive to intravenous immunoglobulin Department of Neurology, University Hospitals of Cleveland/Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA Department of Neurology, University Hospitals of Cleveland/Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA Department of Neurology, University Hospitals of Cleveland/Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA Department of Neurology, University Hospitals of Cleveland/Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA Please review our Terms and Conditions of Use and check box below to share full-text version of article. I have read and accept the Wiley Online Library Terms and Conditions of Use. Use the link below to share a full-text version of this article with your friends and colleagues. Learn more. We report the case of a 13yearold boy with poorly controlled type 2 diabetes mellitus who developed severe diabetic amyotrophy, which progressed over a few months but demonstrated rapid recovery after administration of intravenous immunoglobulin. This report highlights the importance of monitoring adolescents for even the rare neurologic complications of diabetes mellitus most commonly encountered in adults, and supports the need for welldesigned trials using immunomodulatory therapies in diabetic amyotrophy. Muscle Nerve, 2005 Jennifer A Tracy and P James B Dyck, Managing inflammatory diabetic neuropathies, Diabetes Manageme Continue reading >>

Proximal Diabetic Neuropathy

Proximal Diabetic Neuropathy

Proximal diabetic neuropathy, more commonly known as diabetic amyotrophy, is a nerve disorder that results as a complication of diabetes mellitus. It can affect the thighs, hips, buttocks or lower legs. Proximal diabetic neuropathy is a peripheral nerve disease (diabetic neuropathy) characterized by muscle wasting or weakness, pain, or changes in sensation/numbness of the leg.[1] Diabetic neuropathy is an uncommon complication of diabetes. It is a type of lumbosacral plexopathy, or adverse condition affecting the lumbosacral plexus. There are a number of ways that diabetes damages the nerves, all of which seem to be related to increased blood sugar levels over a long period of time. Proximal diabetic neuropathy is one of four types of diabetic neuropathy.[2] Proximal diabetic neuropathy can occur in type 2 and type 1 diabetes mellitus patients however, it is most commonly found in type 2 diabetics.[3] Proximal neuropathy is the second most common type of diabetic neuropathy and can be resolved with time and treatment.[4] Signs & symptoms[edit] Signs and symptoms of proximal diabetic neuropathy depend on the region of the plexus which is affected. The first symptom is usually pain in the buttocks, hips, thighs or legs. This pain most commonly affects one side of the body and can either start gradually or come on suddenly. This is often followed by variable weakness in the proximal muscles of the lower limbs. These symptoms, although often beginning on one side, can also spread to both sides.[1] Weakness in proximal diabetic neuropathy is caused by denervation of the specific muscles innervated by regions of the plexus affected and can thus these muscles may start exhibiting fasciculations. Note that diabetic amyotrophy is a condition caused by diabetes mellitus, but sepa Continue reading >>

Diabetic Lumbosacral Plexopathytreatment & Management

Diabetic Lumbosacral Plexopathytreatment & Management

Diabetic Lumbosacral PlexopathyTreatment & Management Author: Divakara Kedlaya, MBBS; Chief Editor: Milton J Klein, DO, MBA more... Most patients are able to avoid inpatient care for diabetic lumbosacral plexopathy. Good glycemic control through the adjustment of diabetes medication (eg, oral agents, insulin) is of paramount importance. Education on proper diet and exercise is also essential. However, because of the sudden onset of functional loss, some patients with the condition may need to be transferred to a subacute rehabilitation facility or a convalescent home for several months, until they recover strength. A literature review by Kazamel and Dyck suggested that in evaluating patients with diabetes, clinicians should be aware that different types of diabetic neuropathy produce different patterns of abnormal sensation and arise from different pathophysiologic mechanisms. [ 32 ] Go to Diabetes Mellitus, Type 1 ; Diabetes Mellitus, Type 2 ; Diabetic Neuropathy ; and Electrophysiology for more information on these topics. No surgical intervention is needed for diabetic lumbosacral plexopathy. Consider consultation with an endocrinologist (eg, with a diabetologist) to assist with the management of diabetes mellitus. Neurologic recovery is slow for patients with diabetic lumbosacral plexopathy. A physical therapist (PT) can assist in improving a patient's functional mobility (eg, transfers, ambulation). The PT instructs the patient in the use of assistive devices when necessary. A therapeutic exercise and range-of-motion program supervised by the PT is helpful inmaintaining and improving lower extremity prime-mover muscle function and avoiding major lower extremity joint contractures. These patients may derive further benefit from a course of outpatient physical thera Continue reading >>

Diabetic Lumbosacral Plexopathy

Diabetic Lumbosacral Plexopathy

Author: Divakara Kedlaya, MBBS; Chief Editor: Milton J Klein, DO, MBA more... Proximal neuropathy in diabetes mellitus (DM) is a condition in which patients develop severe aching or burning and lancinating pain in the hip and thigh. This is followed by weakness and wasting of the thigh muscles, which often occur asymmetrically. This disabling condition occurs in type 1 and type 2 DM. Bruns first described the disorder in patients with DM in 1890. [ 1 ] In 1955, Garland coined the term diabetic amyotrophy, although the name Bruns-Garland syndrome is also used to describe the condition. [ 2 , 3 , 4 ] Diabetic amyotrophy, which is distinct from other types of diabetic neuropathy, usually has its onset during or after middle age (although it can occur in younger individuals). Concomitant distal, predominantly sensory neuropathy may exist. The results of most electrodiagnostic studies are consistent with the presence of a neurogenic lesion that could be associated with lumbosacral plexopathy, radiculopathy, or proximal crural neuropathy. [ 5 , 6 , 7 , 8 ] However, the exact cause of diabetic lumbosacral plexopathy is not known. [ 9 ] If, as often occurs, the pathology of lumbosacral plexopathyinvolves not only the plexus but also the root and nerve levels, thedisorder is called lumbosacral radiculoplexus neuropathy. [ 10 ] For more information, see Type 1 Diabetes Mellitus , Type 2 Diabetes Mellitus , Diabetic Neuropathy , and Electrophysiology . In evaluating suspected diabetic lumbosacral plexopathy, neural and electrophysiologic studies are generally helpful. Laboratory tests used to diagnose or assess control of diabetes mellitus (eg, fasting blood glucose, hemoglobin A1C) should be performed. In addition, lumbar puncture results may show elevated cerebrospinal fluid (C Continue reading >>

What You Need To Know About Diabetic Amyotrophy

What You Need To Know About Diabetic Amyotrophy

What You Need To Know About Diabetic Amyotrophy Diabetic neuropathy is divided into a few specific types of the disease. This comes from the various types of nerves present in our the body, each serving different functions. The symptoms present and cures will also be dependent on the type of neuropathy you are affected with, but controlling them is more likely the same by managing diabetes properly. The neuropathy types are called proximal neuropathy (also known as diabetic amyotrophy), peripheral neuropathy (also known as distal polyneuropathy or diabetic nerve pain), focal neuropathy (also known as mononeuropathy) and autonomic neuropathy. In this article, we will be talking about proximal neuropathy (also known as diabetic amyotrophy). Diabetic amyotrophy or also known as proximal diabetic neuropathy is a disorder commonly caused by the complications from type 2 diabetes. But patients with type 1 diabetes can also suffer from this condition. The second most frequent type is Proximal neuropathy, after the peripheral diabetic neuropathy, which is the most common of them all. It is often caught by older individuals with diabetes, in opposition to peripheral neuropathy that can be cured with good treatment. The complications of this condition is notable on the buttocks, hips, legs and lower thighs. It is characterized as wasting of the muscles that cause weakness, numbness, pain and aberrations in sensations. These problems are often due to the neural damage caused by the fluctuations of the blood sugar levels of the body. There are several symptoms associated with diabetic amyotrophy. People who suffer from this condition often experience unexplained weight loss and asymmetrical weakness in the lower limbs. Sometimes, patients can experience sharp pains in the hip or t Continue reading >>

Diabetic Amyotrophy: A Rare But Striking Neuropathy

Diabetic Amyotrophy: A Rare But Striking Neuropathy

Diabetic Amyotrophy: A Rare but Striking Neuropathy Clinician Reviews. 2014 April;24(4):23-25 Kristen A. Scheckel practices at Endocrinology Associates in Denver. PREVALENCE AND TYPES OF DIABETIC PERIPHERAL NEUROPATHY According to the CDC, 25.8 million children and adults in the United States (8.3% of the population) have diabetes. Approximately 60% to 70% of them have mild to severe neuropathy.1 Distal symmetric neuropathy is the most common form of diabetic peripheral neuropathy, accounting for more than 50% of cases. It is characterized by distal onset, predominately sensory polyneuropathy, and slow proximal progression.2 In contrast, diabetic amyotrophy is very rare, accounting for only 1% of all cases of neuropathy in diabetes. Prevalence is higher in those with type 2 versus type 1 diabetes (1.1% and 0.3%, respectively).3,4 The most commonly misdiagnosed of the asymmetric diabetic neuropathies, diabetic amyotrophy is characterized by acute, progressive, asymmetrical weakness and pain in the muscles of the proximal lower extremities.5 It is also been referred to as proximal diabetic neuropathy, ischemic mononeuropathy multiplex, diabetic femoral neuropathy, Bruns-Garland syndrome, and diabetic lumbosacral polyradiculopathy.5 The site of the lesion in diabetic amyotrophy remains controversial; it is theorized that diabetic amyotrophy may result from involvement of multiple sites, such as lumbosacral anterior horn cells, motor roots, plexus, or motor axons to the muscles of the proximal lower limbs.4 The pathogenesis remains unknown. One theory is that hyperglycemia may cause metabolic derangements in nerve conduction. Another is that there is ischemic damage followed by axonal degeneration. Immune-mediated inflammatory processes, such as microvasculitis, have also Continue reading >>

Amyotrophy | Johns Hopkins Diabetes Guide

Amyotrophy | Johns Hopkins Diabetes Guide

-- The first section of this topic is shown below -- An underdiagnosed condition referred to by different names including "diabetic proximal neuropathy," "diabetic lumbosacral radiculoplexopathy," and "Bruns-Garland syndrome". Classically, a monophasic illness characterized by acute to subacute onset of severe pain followed by subacute, progressive, asymmetrical limb muscle weakness a few weeks after with variable degrees of recovery. Patients often have some level of concurrent DPN . -- To view the remaining sections of this topic, please sign in or purchase a subscription -- Khoshnoodi, Nima, and Michael Polydefkis. "Amyotrophy." Johns Hopkins Diabetes Guide, Johns Hopkins Guide, 08 November 2018, Accessed 08 November 2018. Khoshnoodi N, Polydefkis M. (Published November 8, 2018). Amyotrophy. Johns Hopkins Diabetes Guide, Johns Hopkins Guide. Retrieved from Khoshnoodi, N., & Polydefkis, M. Amyotrophy. Johns Hopkins Guide. Johns Hopkins Diabetes Guide. Published 2018. Khoshnoodi N, Polydefkis M. Johns Hopkins Diabetes Guide [Internet]. c2018. Amyotrophy; Johns Hopkins Guide. [cited 2018 November 08]; Available from: Continue reading >>

Diabetic Neuropathy: Can It Be Reversed?

Diabetic Neuropathy: Can It Be Reversed?

Neuropathy refers to any condition that damages nerve cells. These cells play a critical role in touch, sensation, and movement. Diabetic neuropathy refers to damage of nerves that’s caused by diabetes. Scientists believe that the high content of blood sugar in the blood of a person with diabetes damages nerves over time. There are several different types of neuropathies. They include: Peripheral: Pain and numbness in the extremities including arms, feet, legs, hands, and toes Proximal: Pain and numbness in the upper legs, specifically the buttocks, thighs, and hips Autonomic: Damage to nerves of the autonomic nervous system which control sexual response, sweating, urinary and digestive function Focal: Sudden loss of function in nerves causing pain and weakness of the muscles Neuropathy is one of the common effects of diabetes. It’s estimated that 60-70 percent of people with diabetes will develop some sort of neuropathy throughout their lives. By 2050, it’s estimated that over 48 million people in the United States will be diagnosed with diabetes. That means in the future, anywhere from 28-33 million Americans could be affected by diabetic neuropathy. Nerve damage from diabetes cannot be reversed. This is because the body can’t naturally repair nerve tissues that have been damaged. However, researchers are investigating methods to treat nerve damage caused by diabetes. While you cannot reverse the damage from neuropathy, there are ways to help manage the condition, including: lowering your blood sugar treating nerve pain regularly checking your feet to make sure they are free of injury, wounds, or infection Controlling your blood glucose is important because it can help prevent additional damage to your nerves. You can better control your blood glucose through Continue reading >>

Diabetic Amyotrophy

Diabetic Amyotrophy

Diabetic amyotrophy is a nerve disorder complication of diabetes mellitus. It affects the thighs, hips, buttocks and legs, causing pain and muscle wasting. What is diabetic amyotrophy? Diabetic amyotrophy is a nerve disorder which is a complication of diabetes mellitus. It affects the thighs, hips, buttocks and legs, causing pain and muscle wasting. It is also called by several other names, including proximal diabetic neuropathy, lumbosacral radiculoplexus neurophagy and femoral neurophagy. What is diabetic amyotrophy like? The main features of diabetic amyotrophy are: Weakness of the lower legs, buttocks or hip. Muscle wasting, usually in the front of the thigh, which follows within weeks. Pain, sometimes severe, usually in the front of the thigh but sometimes in the hip, buttock or back. Other features which occur in some (but not all) patients are: Altered sensation and tingling in the thigh, hip or buttock, which tends to be mild in comparison to the pain and weakness. About half of patients also have distal neuropathy, meaning that sensation in the nerves of the lower legs and feet may be separately affected by this condition (which is the most common form of diabetic neuropathy). Learn more about diabetic neuropathy. About half of people affected lose weight. Symptoms generally begin on one side and then spread to the other in a stepwise progression. The condition may come on quickly or more slowly and usually remains asymmetrical (ie the two sides of the body are unequally affected) throughout its course. About half of patients also have distal symmetrical polyneuropathy, which means the sensation in their feet and toes on both sides is also affected. The condition tends to go on for several months but can last up to three years. By the end of this time it usuall Continue reading >>

Evaluation And Prevention Of Diabetic Neuropathy

Evaluation And Prevention Of Diabetic Neuropathy

Diabetic Autonomic Neuropathy Diabetic autonomic neuropathy can develop in patients with type 1 or type 2 diabetes. Although autonomic neuropathy may occur at any stage of diabetes,3,4 usually it develops in patients who have had the disease for 20 years or more with poor glycemic control. The reported prevalence of diabetic autonomic neuropathy varies widely, depending on the cohort studied and the methods of assessment.7 In autonomic disease, the sympathetic, parasympathetic, and enteric nerves are affected. Myelinated and unmyelinated nerve damage is found. Diabetic autonomic neuropathy may lead to hypoglycemic unawareness and increased pupillary latency. Many investigators have considered autonomic neuropathies to be irreversible. However, cardiac sympathetic dysinnervation has been shown to regress with tight glycemic control.8 CARDIOVASCULAR AUTONOMIC NEUROPATHY The risk of cardiovascular events is at least two to four times higher in patients with diabetes.9 Cardiovascular neuropathy is a result of damage to vagal and sympathetic nerves. Clinical findings may include exercise intolerance, persistent sinus tachycardia, no variation in heart rate during activities, and bradycardia. Baroreceptor disease contributes to supine hypertension. In a patient with type 1 diabetes, an autonomic imbalance may result in a prolonged QT interval on the electrocardiogram (ECG), which may predispose the patient to life-threatening cardiac arrhythmias and sudden death.7 Diabetic neuropathy also can reduce appreciation of ischemic pain, which may delay appropriate medical therapy and lead to death.7 Orthostatic blood pressure measurements may be used to evaluate cardiovascular autonomic dysfunction.10 Stress testing should be considered before any patient with diabetes starts an exe Continue reading >>

Diabetic Neuropathy Part 2: Proximal And Assymmetric Phenotypes

Diabetic Neuropathy Part 2: Proximal And Assymmetric Phenotypes

DIABETIC NEUROPATHY PART 2: PROXIMAL AND ASSYMMETRIC PHENOTYPES Mamatha Pasnoor , MD, Assistant Professor, Mazen M. Dimachkie , M.D., Professor of Neurology, and Richard J. Barohn , MD, Professor and Chairman Mamatha Pasnoor, Department of Neurology, University of Kansas Medical Center, Kansas City, KS; The publisher's final edited version of this article is available at Neurol Clin See other articles in PMC that cite the published article. Diabetic neuropathies consist of a variety of syndromes resulting from different types of damage to peripheral or cranial nerves. Although distal symmetric polyneuropathy is most common type of diabetic neuropathy, there are many other subtypes of diabetic neuropathies which have been defined since the 1800s. Included in these descriptions are patients with proximal diabetic, truncal, cranial, median, and ulnar neuropathies. Various theories have been proposed for the pathogenesis of these neuropathies. The treatment of most of these requires tight and stable glycemic control. Spontaneous recovery is seen in most of these conditions with diabetic control Immunotherapies have been tried in some of these conditions but are quite controversial. Keywords: Diabetic, Asymmetric, Neuropathies Distal symmetric polyneuropathy is most common type of neuropathy associated with diabetes. However, many subtypes of diabetic neuropathies were defined even as early as in the 1800s. 1 4 Included in these descriptions are patients with proximal diabetic neuropathy, truncal neuropathy, limb mononeuropathies and cranial neuropathies ( Table 1 ). Bruns focused further on the entity of proximal diabetic neuropathy. 5 Various theories have been proposed for the pathogenesis of these neuropathies. Treatment in most cases tight and stable glycemic control a Continue reading >>

Diabetic Proximal Neuropathy: Getting At The Root Of The Problemnew Insights Into Diagnosis And Treatment

Diabetic Proximal Neuropathy: Getting At The Root Of The Problemnew Insights Into Diagnosis And Treatment

Diabetic proximal neuropathy is among the most unusual and disabling forms of peripheral neuropathy, causing major suffering among affected individuals. Alternately referred to as lumbosacral radiculoplexus neuropathy, femoral neuropathy, diabetic neuropathic cachexia, or diabetic amyotrophy, the condition is characterized by severe, typically asymmetric leg pain and weakness, predominantly proximal to the muscles around the hip and knee. Although monophasic, diabetic proximal neuropathy is associated with prolonged morbidity due to relentless pain and focal weakness, according to Anthony J. Windebank, MD, Professor of Neurology at the Mayo Clinic College of Medicine in Rochester, MN. Because patients usually improve with time, physicians may underappreciate their pain and suffering. At the peak of their illness, patients are typically confined to a wheelchair and even if mobile, unable to work. Even after recovery, most are left with residual weakness. Complicating the situation, experts told Neurology Today, is that the symptoms often mimic those of other, more common illnesses, which can result in misdiagnosis and unnecessary, inappropriate treatments. Despite numerous studies, the underlying pathogenesis of diabetic proximal neuropathy is still not clearly understood. But research done in the last few years is providing new insights into its natural history, diagnosis, and treatment. Diabetic proximal neuropathy often begins so abruptly that patients can recall the exact day the symptoms began, Dr. Windebank said. The disease develops acutely, reaches a plateau, and gradually improves over time. The initial pain can be sharp or lancinating, or deep or burning, said P. James B. Dyck, MD, Consultant of Neurology and Co-Director of the Peripheral Nerve Laboratory at t Continue reading >>

Amyotrophy - An Overview | Sciencedirect Topics

Amyotrophy - An Overview | Sciencedirect Topics

Amyotrophy is an asymmetric lower limb motor neuropathy also known as diabetic lumbosacral plexus neuropathy and Bruns-Garland syndrome. Antonino Uncini, Antonio Di Muzio, in Handbook of Clinical Neurophysiology , 2004 Focal amyotrophy of upper limb was initially described in Japan and other Asian countries, but subsequently throughout the world. Hundreds of patients have been reported but the incidence and prevalence remain unknown. In India monomelic amyotrophy represents up to 1123% of the patients with motor neuron disease (Gourie-Devi et al., 1984; Saha et al., 1997) suggesting some ethnic predisposition or the effect of an environmental factor. In comparison, focal amyotrophy of upper limb in western countries is quite rare. In our Center we collected five cases in 12 years. Gerald Charnogursky*, ... Norma Lopez, in Handbook of Clinical Neurology , 2014 Asymmetric lower limb motor neuropathy (amyotrophy) Amyotrophy is an asymmetric lower limb motor neuropathy also known as diabetic lumbosacral plexus neuropathy and Bruns-Garland syndrome. Patients typically present with an asymmetric, painful muscle wasting and weakness affecting the lower limbs and loss of reflexes and objective weakness on examination. Patients may describe a sudden onset of sharp pain in the hip and thigh that can spread to the opposite side over weeks to months, generally in a stepwise and steady progression affecting both proximal and distal muscles (Barohn et al., 1991). Amyotrophy is more likely to affect middle to older aged patients. Electrodiagnostic studies are useful in ruling out other conditions that may account for the symptoms of amytrophy. Adam M. Sonabend, ... Christopher Winfree, in Schmidek and Sweet Operative Neurosurgical Techniques (Sixth Edition) , 2012 Neuralgic amyotroph Continue reading >>

Non-diabetic Lumbosacral Radiculoplexus Neuropathy: Natural History, Outcome And Comparison With The Diabetic Variety

Non-diabetic Lumbosacral Radiculoplexus Neuropathy: Natural History, Outcome And Comparison With The Diabetic Variety

Diabetic lumbosacral radiculoplexus neuropathy (DLSRPN) (other names include diabetic amyotrophy) is well recognized, unlike the non-diabetic lumbosacral radiculoplexus neuropathy (LSRPN), which has received less attention. Our objective was to characterize the natural history and outcome of LSRPN and to assess whether it is similar to the diabetic variety in its symptoms, course, electrophysiological features, quantitative sensory and autonomic findings, and the underlying pathophysiology. We studied 57 patients with LSRPN and 33 patients with DLSRPN. We found that the age of onset, course, kind and distribution of symptoms and impairments, laboratory findings and outcomes are essentially alike. Both disorders are a lumbosacral plexus neuropathy associated with weight loss, often beginning focally or asymmetrically in the thigh or leg but usually progressing to involve the initially unaffected segment and the contralateral side. Both have prolonged morbidity due to pain, paralysis, autonomic involvement and sensory loss. In biopsied distal LSRPN nerves, we found changes similar to those found in DLSRPNalterations typical of ischaemic injury and of microvasculitis. The long-term outcome was determined in 42 LSRPN patients: two had become diabetic, seven had relapsed and only three had recovered completely, although all had improved. We conclude that: (i) LSRPN is a subacute, asymmetrical, painful and debilitating neuropathy of the lower limbs associated with weight loss, and we think it is under-recognized; (ii) recovery from the long-term impairments of LSRPN is usually delayed and incomplete and only a small minority of patients develop diabetes mellitus; (iii) LSRPN mirrors the diabetic variety in its clinical features, course, pathological findings (ischaemic injur Continue reading >>

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