Diabetic myelopathy

Diabetic myelopathy occurred in 41% of 75 consecutive, unselected diabetic patients in an autopsy study; clinical peripheral neuropathy occurred in 13%, and histologic radiculopathy in 21%. Infection represented 2.7% of the cord lesions. Posterior column demyelination, seen in 27%, apparently has the same metabolic-toxic origin as diabetic neuropathy and radiculopathy; it is an independent lesion, not a secondary manifestation of peripheral demyelination. It occurs slightly more frequently in those with juvenile-onset diabetes. Spinal cord infarcts, seen in 19%, are related to anteriolar sclerosis of the intrinsic vessels of the spinal cord. They have a higher incidence in diabetics than in a nondiabetic aging population, show a predilection for the white matter, and are usually small. The myelopathy is not related to patient age or duration of diabetes. It is often clinically occult.