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Microvasculitis in diabetic lumbosacral radiculoplexus neuropathy
Jennifer A Tracy1, JaNean K Engelstad, P James B Dyck
1Peripheral Neuropathy Research Laboratory, Mayo Clinic, Rochester, MN 55905, USA.
Journal of Clinical Neuromuscular Disease
|September 5, 2009
Summary
This case study highlights diabetic lumbosacral radiculoplexus neuropathy, a condition causing progressive leg weakness. Nerve biopsy confirmed active injury, and treatment with methylprednisolone led to significant symptom improvement.
Area of Science:
- Neurology
- Endocrinology
- Pathology
Background:
- Type 2 diabetes mellitus can lead to complex neurological complications.
- Diabetic lumbosacral radiculoplexus neuropathy (DLRPN) is a debilitating condition affecting the nerves in the lower back and legs.
Observation:
- A 60-year-old man with type 2 diabetes presented with a year of worsening bilateral lower limb weakness, numbness, and pain, requiring a walker.
- Clinical evaluation revealed elevated cerebrospinal fluid protein, abnormal sensory testing, and electrodiagnostic findings consistent with lumbosacral radiculoplexus neuropathies.
Findings:
- A superficial peroneal nerve biopsy demonstrated active axonal degeneration, ischemic injury, and microvasculitis, confirming active DLRPN.
- Quantitative sensory testing and nerve conduction studies/electromyography provided crucial diagnostic information.
Implications:
- Nerve biopsy is valuable for assessing disease activity in suspected DLRPN.
- Intravenous methylprednisolone treatment resulted in marked improvement of neurological symptoms and signs.
- This case underscores the importance of recognizing and managing DLRPN in diabetic patients.
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