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 >>
- The Natural History of Type 2 Diabetes: Practical Points to Consider in Developing Prevention and Treatment Strategies
- Type 2 diabetes: What happens if symptoms go undetected? How to avoid dangerous outcome | Health | Life & Style | Express.co.uk
- Natural Herbs For Diabetes: 5 Natural Remedies For Diabetes That Work!
Diabetic Cervical Radiculoplexus Neuropathy: A Distinct Syndrome Expanding The Spectrum Of Diabetic Radiculoplexus Neuropathies
Diabetic cervical radiculoplexus neuropathy: a distinct syndrome expanding the spectrum of diabetic radiculoplexus neuropathies 1 Department of Neurology, Hpital du Sacr-Coeur de Montral, Montral, Qc, H4J 1C5, Canada 2 Department of Neurology, Mayo Clinic Rochester, Rochester, MN 55905, USA Search for other works by this author on: 2 Department of Neurology, Mayo Clinic Rochester, Rochester, MN 55905, USA Search for other works by this author on: 2 Department of Neurology, Mayo Clinic Rochester, Rochester, MN 55905, USA Search for other works by this author on: 3 Department of Radiology and Mayo Clinic Rochester, Rochester, MN 55905, USA Search for other works by this author on: 4 Department of Biostatistics, Mayo Clinic Rochester, Rochester, MN 55905, USA Search for other works by this author on: 2 Department of Neurology, Mayo Clinic Rochester, Rochester, MN 55905, USA Search for other works by this author on: 2 Department of Neurology, Mayo Clinic Rochester, Rochester, MN 55905, USA Search for other works by this author on: 2 Department of Neurology, Mayo Clinic Rochester, Rochester, MN 55905, USA Search for other works by this author on: Brain, Volume 135, Issue 10, 1 October 2012, Pages 30743088, Rami Massie, Michelle L. Mauermann, Nathan P. Staff, Kimberly K. Amrami, Jayawant N. Mandrekar, Peter J. Dyck, Christopher J. Klein, P. James B. Dyck; Diabetic cervical radiculoplexus neuropathy: a distinct syndrome expanding the spectrum of diabetic radiculoplexus neuropathies, Brain, Volume 135, Issue 10, 1 October 2012, Pages 30743088, Diabetic lumbosacral radiculoplexus neuropathy is a subacute painful, asymmetrical lower limb neuropathy due to ischaemic injury and microvasculitis. The occurrence of a cervical diabetic radiculoplexus neuropathy has been postulated. Ou Continue reading >>
Diabetic Amyotrophy: What Is It?
After answering the question what is diabetes, you may continue to ask what diabetic amyotrophy is and get an answer that goes: it is a type of neuropathy experienced by Type 2 diabetic patients, the outcome of which is pain, weakness, etc. Obviously, your second question could be: what is neuropathy in the first place? To get the basic facts right, neuropathy is inflammation of the nerves that are outside the brain and spinal cord. Hence this condition is often called peripheral neuropathy. The inflammation could be due to injury to the nerves or a result of some metabolic disorder. Incidentally, Diabetics suffer from some form of neuropathy. Coming back to our topic of discussion, diabetic amyotrophy is a painful condition characterized by muscle wasting and weakness. It primarily affects the muscles of the thigh and pelvic girdle. The pain can also affect toes, feet, legs, hands and arms. It is also known by other names including proximal diabetic neuropathy or lumbosacral radiculoplexus neuropathy, Bruns-Garland Syndrome, etc. Diabetic Neuropathy can be of Different Types They can be classified as peripheral, autonomic, proximal, or focal, depending on the nerves damaged by diabetes. Diabetic amyotrophy is in essence peripheral neuropathy, the most common type, characterized by damage of nerves of the arms and legs. What are the Early Symptoms of Diabetic Amyotrophy? Generally affecting more Type 2 diabetic patients than Type 1, severe pain and weakness of thigh muscles along with that of hip and buttocks at night is one of the early signs. Such pain and subsequent weakness may be centralized on one side and gradually move on to the other side also. The pain could also affect the shin and feet. Other symptoms include loss of knee and ankle reflex. Other symptoms , Continue reading >>
Diabetic Lumbosacral Radiculoplexus Neuropathy: A Postmortem Studied Patient And Review Of The Literature
, Volume 258, Issue7 , pp 13641367 | Cite as Diabetic lumbosacral radiculoplexus neuropathy: a postmortem studied patient and review of the literature Sural NerveNerve BiopsySural Nerve BiopsyFemoral Cutaneous NerveLumbosacral Plexus These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves. Peripheral neuropathy is an important complication of diabetes mellitus. A particular type of proximal diabetic neuropathy, lumbosacral radiculoplexus neuropathy (DLSRPN), presents with pelvi-femoral pain followed by weakness, beginning focally in the upper leg or thigh with spread to the contralateral limb, and variable weight loss [ 1 ]. Ischemic nerve injury due to microscopic vasculitis has been a widely postulated unifying hypothesis of DLSRPN and derived from one well studied postmortem case reported 4decades ago, the finding of microscopic vasculitis in proximal or distal cutaneous nerve biopsy tissue and the favorable response to immunotherapy. A 59year old man with diabetes mellitus for 15years treated with oral hypoglycemic medication noted left thigh pain, paresthesia, and impotence commencing in January 1995. This was followed by sensory changes and weakness first in the left leg then in the other in a stepwise fashion leading first to the necessity of a cane, then walker accompanied by a 15lb weight loss, until he was essentially bed-bound and admitted to the hospital in June 1995. Admission neurological examination showed wasting and near-flail weakness in the legs from the thighs to the toes with rare limb fasciculation, mild distal weakness of the hands in the distribution of the distal median and ulnar nerves, mild stocking sensory loss to light touch, vibratory and c Continue reading >>
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 >>
Aziz I Shaibani MD (Dr. Shaibani of Baylor College of Medicine has no relevant financial relationships to disclose.) Dr. Weimer of Columbia University has received consulting fees from Roche. This article includes discussion of diabetic amyotrophy, Bruns-Garland syndrome, diabetic lumbosacral radiculoplexus neuropathy, diabetic mononeuritis multiplex , diabetic polyradiculopathy, and proximal diabetic neuropathy . The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations. Diabetic amyotrophy is predominantly a motor condition that involves various elements of the lumbosacral plexus, particularly those related to the femoral nerve. It usually presents acutely as unilateral thigh pain followed by weakness and later wasting in the anterior thigh muscles. Diabetic amyotrophy typically occurs in older patients with type 2 diabetes. An immune-mediated epineurial microvasculitis has been demonstrated in nerve biopsies. When severe and progressive, predominantly motor polyneuropathy develops in diabetic patients, one must also consider chronic inflammatory demyelinating polyradiculoneuropathy . In this article, the authors discuss recent studies that have provided novel insights into the pathogenesis of diabetic amyotrophy, leading to the establishment of formal clinical trials of mechanistically relevant therapies like immunoglobulin and methylprednisolone. It is important, and sometimes difficult, to differentiate diabetic amyotrophy from chronic inflammatory demyelinating polyradiculoneuropathy . The syndrome of wasting and weakness of the pelvifemoral muscles associated with diabetes mellitus was originally described by Ludwig Bruns in 1890 ( Bruns 1890 ). Many years later, Garland and Taverner expanded the description ( Garland an Continue reading >>
Diabetic Amyotrophy: Current Concepts.
(1)Department of Neurology, Saint Vincents Hospital and Medical Center of New York, New York Medical College, NY 10011, USA. Diabetic amyotrophy is a disabling illness that is distinct from other forms ofdiabetic neuropathy. It is characterized by weakness followed by wasting ofpelvifemoral muscles, either unilaterally or bilaterally, with associated pain.Sensory impairment is minimal in the cutaneous distribution sharing the same rootor peripheral nerve as affected musculature. Most commonly, the onset is inmiddle age or later, although it may occur in youth. A concomitant distalpredominantly sensory neuropathy may be present. Electrodiagnostic studies aremost often consistent with a neurogenic lesion attributable to a lumbosacralradiculopathy, plexopathy, or proximal crural neuropathy. The natural course ofthe illness is variable with gradual but often incomplete improvement. The siteof the lesion and the pathogenesis of diabetic amyotrophy remain controversial.Recent studies suggest a role for immunomodulating agents in certain types ofdiabetic neuropathy, including diabetic amyotrophy. Continue reading >>
Diabetic And Non-diabetic Lumbosacral Radiculoplexus Neuropathy.
1. Neurol India. 2008 Oct-Dec;56(4):420-5. Diabetic and non-diabetic lumbosacral radiculoplexus neuropathy. (1)Departments of Neurology, Emory University, Atlanta, Georgia and University of Minnesota, Minneapolis, Minnesota 55455, USA. BACKGROUND: Lumbosacral radiculoplexus neuropathy (LRPN) originally described in diabetic patients is a distinct clinical condition characterized by debilitating pain, weakness and atrophy most commonly affecting the proximal thigh musclesasymmetrically. The syndrome is usually monophasic and preceded by significantweight loss (at least more than 10 lbs). Though a self-limited condition,recovery is gradual with some residual weakness. Recent advances and research hasprovided new insights in the pathogenesis and thereby management of thissyndrome. In this paper, we review the clinical and diagnostic features as wellas discuss recent insights and treatment strategies along with our experience in the management of patients with diabetic and non-diabetic LRPN.MATERIALS AND METHODS: Literature in English published between 1953 and 2008 was searched in the MEDLINE and Pubmed database, maintained by the US Nationallibrary of medicine and National institutes of health, using key words ofdiabetic amyotrophy, lumbosacral radiculoplexus neuropathy, diabetic proximalneuropathy, diabetic radiculopathy and diabetic lumbosacral plexopathy. Inaddition, literature reported in various textbooks on peripheral neuropathy wasreviewed as well.OBSERVATION: The diagnosis relies mostly on clinical suspicion and characteristicelectromyographic findings. The exact pathogenesis of the illness remainsunknown, but there seems to be a component of immune-mediated inflammatorymicrovasculitis which causes secondary ischemia of the lumbosacral plexus. Thishas prompted a Continue reading >>
Diabetes Amyotrophy: Causes, Symptoms And Treatment
written by: DulceCorazon edited by: Diana Cooper updated: 8/24/2010 Diabetes amyotrophy is one of four types of neuropathy that can affect diabetics. Learn more of its symptoms and causes. There are four types of diabetic neuropathy. Peripheral neuropathy, the most common form, affects the feet, legs, arms and hands. Autonomic neuropathy affects the bladder, lungs, heart, stomach, eyes, intestines and sex organs. Mononeuropathy causes damage to one single nerve, usually in the legs, arms or face. Radiculoplexus neuropathy, also known as diabetic amyotrophy, affects the nerves closer to the hips and shoulders. It is a potentially disabling condition that is sometimes seen among people with type 2 diabetes. The condition often occurs in middle aged and elderly individuals who may not know that they suffer from diabetes. In fact, in almost one-third of the cases, amyotrophy led to the diagnosis of diabetes.It is estimated that about one percent of people with diabetes may suffer from this condition, also known as Bruns-Garland Syndrome. The condition stems from diabetic neuropathy, a complication of diabetes . Diabetic neuropathy occurs when a person's diabetes is uncontrolled, and is characterized by the malfunction of the nerves in the body. When the flow of blood to the legs is decreased in diabetics, nutrients and other substances required by the legs for proper functioning are then minimally transported. This further exacerbates the condition. There are several symptoms associated with diabetic amyotrophy. People who have this condition often experience unexplained weight loss and suffer asymmetrical weakness in the lower limbs. They may experience sudden and sharp pains in one thigh and hip area, possibly spreading to the other side. There is also a noticeable weakn Continue reading >>
The Signs & Symptoms Of Diabetic Neuropathy
When it comes to diabetic neuropathy, there are actually four primary categories. You may experience the signs of just one or several at a given time. Most cases of diabetic neuropathy develop quite gradually, and patients probably won’t notice any of the symptoms until after the nerves have suffered significant damage. The symptoms associated with this disease will vary based on the type of neuropathy (peripheral neuropathy, autonomic neuropathy, radiculoplexus neuropathy, or mononeuropathy) and the nerves which are primarily affected. People who are diagnosed with this disease are often encouraged to enroll in a diabetic neuropathy clinical trial, since there is still no cure. Peripheral Neuropathy This is actually the most common type of diabetic neuropathy. The nerves in the patient’s legs and feet are attacked first, followed by their arms and hands. All of the following are symptoms which have been associated with peripheral neuropathy: Not able to feel changes in the weather or pain which is followed by numbness in the affected area Burning or tingling sensation Experiencing unusual pain during a walk Extremely sensitive level of pain in the area – could hurt just to be touched Difficulty walking and weak muscles Sharp, stabbing pain that can become worse during the night Complications in the feet, including ulcers, joint pain, infections, and even deformities Autonomic Neuropathy The human autonomic nervous system helps to control the actions of the vital organs like the lungs, heart, intestines, sex organs, and eyes. If your disease begins to attack the nerves in any of these areas, then it could cause any of the following indications: Bladder problems such as frequent urinary tract infections and urinary incontinence Blood sugar levels may drop without t Continue reading >>
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 >>
The Four Types Of Diabetic Neuropathy
Most of us associate peripheral neuropathy with diabetes. What might be a surprise is that there are three other forms of neuropathy that are also common to diabetics. Diabetic neuropathy is the result of prolonged periods of excess glucose in the blood damaging fragile nerve fibers. Hyperglycemia also damages the walls of the many blood vessels in the body, including the capillaries that provide the blood supply that supports the nervous system. Finally, high glucose levels interfere with the ability of the nerves to send signals. Taken together, this triad of damage causes first numbness, then extreme pain, in the nerves in various areas of the body. Peripheral Neuropathy This is the most common form of neuropathy to afflict diabetics. Symptoms usually begin in the feet and legs, then move to the hands and arms. Symptoms include: Numbness Loss of pain or temperature sensation Tingling or burning Acute sensitivity to touch Sharp pains or cramps Bone and joint pain Muscle weakness Loss of reflexes, beginning with the ankle Loss of balance and coordination Acute injury to the foot, including ulcerations, infections, deformities Autonomic Neuropathy The autonomic nerves are the ones that control the beating of the heart, breathing, bladder control, movement of stomach contents, movement of waste through the intestines and sexual response. These are the nerves that act without being directed by conscious thought. Symptoms include: Hypoglycemic unawareness (an inability to sense that blood glucose has dropped too low) Bladder issues (infections, retention or incontinence) Constipation or uncontrollable diarrhea, or both Gastroparesis (slowed emptying of the stomach) Difficulty swallowing Erectile dysfunction Sexual difficulties in women Increased or decreased sweating Probl Continue reading >>
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. 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. Proximal diabetic neuropathy can occur in type 2 and type 1 diabetes mellitus patients however, it is most commonly found in type 2 diabetics. Proximal neuropathy is the second most common type of diabetic neuropathy and can be resolved with time and treatment. Signs & symptoms 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. 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 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 >>
Distinctive Pathologic Findings In Proximal Diabetic Neuropathy (diabetic Amyotrophy)
Distinctive pathologic findings in proximal diabetic neuropathy (diabetic amyotrophy) Praful Kelkar, Moeen Masood and Gareth J. Parry First published July 12, 2000, DOI: Distinctive pathologic findings in proximal diabetic neuropathy (diabetic amyotrophy) Praful Kelkar, Moeen Masood, Gareth J. Parry Neurology Jul 2000, 55 (1) 83-88; DOI: 10.1212/WNL.55.1.83 This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased. Objective: To investigate the pathogenesis of proximal diabetic neuropathy (PDN) with nerve and muscle biopsies. Background: Recent evidence suggests that nerve ischemia secondary to immune-mediated vasculopathy rather than diabetic microangiopathy may be responsible for PDN.Method: Fifteen patients with PDN and two diabetic controls underwent nerve and muscle biopsy and clinical, electrophysiologic, and laboratory evaluation. There were eight men and seven women between 49 and 79 years of age with type II diabetes. All had progressive, painful, asymmetric, proximal weakness with duration of 5 weeks to 12 months. None had evidence of systemic autoimmune disorder. Results: Four patients showed the distinctive findings of polymorphonuclear small-vessel vasculitis affecting epineurial vessels with transmural infiltration of postcapillary venules with polymorphonuclear leukocytes. Immunoglobulin M (IgM) deposits were found along the endothelium and intramurally in affected vessels. IgM staining was seen in the subperineurial space and in the endoneurium. Activated complement deposition was seen along endothelium of small vessels. Three of these four patients were evaluated within 6 seeks of onset of PDN, and the fourth patient during ac Continue reading >>