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Diabetic neuropathy simulating conus medullaris syndrome
1Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799.
Archives of Internal Medicine
|February 1, 1988
Summary
Diabetic patients with fecal incontinence may have conus medullaris syndrome, even without a mass lesion. This condition, distinct from diabetic neuropathy, requires further investigation beyond typical diabetic complications.
Area of Science:
- Neurology
- Endocrinology
- Gastroenterology
Background:
- Diabetic neuropathy is a common complication in long-standing insulin-dependent diabetes mellitus.
- Conus medullaris syndrome typically presents with neurological deficits affecting the lower extremities and bowel/bladder function.
Observation:
- Two diabetic patients presented with fecal incontinence, poor rectal sphincter tone, perianal hypoesthesia, and absent Achilles reflexes.
- These clinical signs were suggestive of conus medullaris syndrome.
Findings:
- No identifiable mass lesion was found on investigation to explain the observed symptoms.
- The presentation indicated an etiology other than typical diabetic neuropathy, particularly in the absence of back pain and significant autonomic/peripheral neuropathy.
Implications:
- Highlights the importance of considering conus medullaris syndrome in diabetic patients with specific lower-extremity and bowel dysfunction.
- Suggests that fecal incontinence in diabetics, when accompanied by specific neurological signs, may warrant investigation for spinal cord pathology beyond diabetic neuropathy.
- Emphasizes the need for a differential diagnosis that includes structural spinal cord lesions in diabetic patients presenting with these symptoms.