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Summary
Diabetic neuropathy involves focal fascicular lesions, likely from microangiopathy, causing nerve fiber loss. These ischemic lesions contribute significantly to the development of neuropathy in diabetic patients.
Area of Science:
- Neurology
- Pathology
- Diabetology
Background:
- Diabetic polyneuropathy is a common complication of diabetes mellitus.
- Its pathogenesis is complex, involving metabolic and vascular factors.
Purpose of the Study:
- To investigate the role of focal fascicular lesions in the development of diabetic neuropathy.
- To compare nerve pathology in diabetic and nondiabetic individuals.
Main Methods:
- Autopsy samples of lumbosacral trunk, posterior tibial nerve, and sural nerve were analyzed.
- Histological evaluation included epoxy sections and teased nerve fiber preparations.
- Nerve samples were from diabetic and nondiabetic patients without mononeuropathy multiplex.
Main Results:
- Focal fascicular lesions, characterized by reduced myelinated axon density, were prevalent in diabetic nerve samples, particularly the posterior tibial nerve and lumbosacral trunk.
- Severe lesions showed damage to the perineurium and epineurium, suggesting an ischemic origin.
- A significant proximal-to-distal gradient of myelinated fiber loss was observed in diabetics, correlated with focal lesions.
- Abnormalities in teased nerve fibers were common in sural nerves of diabetics, likely secondary.
Conclusions:
- Focal fascicular lesions, likely caused by diabetic microangiopathy, are a significant factor in diabetic neuropathy development.
- These ischemic lesions contribute to distal nerve fiber loss beyond metabolic derangements.
- Diabetic neuropathy pathogenesis involves both metabolic abnormalities and vascular complications.