Search
diabetic amyotrophy/lumbar polyradiculopathy; diabetic lumbosacral radiculoplexus neuropathy (DLRPN)
Etiology:
- diabetes mellitus
- may follow a period of weight loss due to illness [1]
Pathology:
1) subacute lumbosacral plexopathy
2) involvement of L2, L3, L4 nerve roots
3) primarily affects muscles of the thigh
4) inflammation suggested by nerve & muscle biopsy
a) immune complex & complement deposition
b) vasculitis
c) neutrophil infiltration
Clinical manifestations:
1) severe thigh pain is usual presentation
2) proximal muscle weakness & numbness develop over weeks to months
3) may be bilateral with symptoms in contralateral leg occuring days to months to years later
4) with or without proximal sensory loss
5) no involvement of the upper extremities
6) no diffuse areflexia
4) symptoms stabilize (but may persist) after 6 months
5) recovery in 6 months to 2 years
Special laboratory:
- electromyography after a period of 3 weeks [1]
- may reveal denervation & axonal loss
- nerve conduction studies
- no diffuse motor nerve abnormalities
Radiology:
- MRI of lumbar spine to rule out cauda equina syndrome
- CT of abdomen to rule out retroperitoneal hematoma [1]
Differential diagnosis:
- chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
- Guillain-Barre syndrome
- statin myopathy
Management:
1) intravenous immune globulin may be of benefit
2) prednisone may be of benefit
3) plasma exchange may be of benefit
Related
diabetic polyneuropathy
Specific
painless diabetic motor neuropathy
General
lumbosacral radiculoplexus neuropathy
neurogenic muscle atrophy; denervation atrophy
diabetic neuropathy
References
- Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 19.
American College of Physicians, Philadelphia 2012, 2015, 2021
- Younger DS.
Diabetic lumbosacral radiculoplexus neuropathy: a
postmortem studied patient and review of the literature.
J Neurol. 2011 Jul;258(7):1364-7
PMID: 21327851
- UpToDate, Online 10.3, 2002
http://www.uptodate.com