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Proximal diabetic neuropathy presenting with respiratory weakness.

T H Brannagan1, R A Promisloff, L F McCluskey

  • 1MCP-Hahnemann University School of Medicine, Department of Neurology, Pennsylvania, Philadelphia 19102, USA. Brannagan@drexel.edu

Journal of Neurology, Neurosurgery, and Psychiatry
|September 16, 1999
PubMed
Summary

Proximal diabetic neuropathy can cause respiratory weakness, affecting breathing and leg muscles. This condition in a 50-year-old man improved spontaneously, highlighting a potential neuromuscular cause for breathing difficulties.

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Area of Science:

  • Neurology
  • Pulmonology
  • Diabetology

Background:

  • Diabetic neuropathy is a common complication of diabetes mellitus.
  • Neuromuscular respiratory weakness can arise from various conditions, impacting diaphragm and intercostal muscle function.
  • Proximal diabetic neuropathy, affecting muscles closer to the body's core, is less commonly associated with respiratory compromise.

Observation:

  • A 50-year-old male patient presented with progressive shortness of breath over two months.
  • The patient also exhibited proximal muscle weakness, specifically affecting hip flexion.
  • Electrophysiological studies revealed absent phrenic nerve responses and abnormal activity in other respiratory muscles.

Findings:

  • Electromyography showed spontaneous activity in intercostal and lumbar paraspinal muscles.

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  • Motor unit potentials (MUPs) in the diaphragm were of long duration with reduced recruitment, indicating significant neuromuscular impairment.
  • Despite the absence of specific treatment, the patient experienced spontaneous improvement in both respiratory function and proximal leg strength.

    • Implications:

    • This case highlights proximal diabetic neuropathy as a potential cause of neuromuscular respiratory weakness.
    • The findings suggest that respiratory muscle involvement can occur in proximal diabetic neuropathy.
    • Understanding this association is crucial for diagnosing and managing respiratory complications in diabetic patients.