Diabetic Neuropathy

Diseases, , , ,

There are various types of diabetic neuropathy

Diabetic polyneuropathy (sensory type and sensorimotor type):

Diagnosis:

Features of polyneuropathy and meeting criteria for diabetes mellitus

Clinical features:

Symmetric sensory polyneuropathy, loss of vibration, pain, touch and temperature sensation and in some cases proprioception loss and Charcot joints
Areflexia
Painful
May become sensorimotor

Pathology, nerve biopsy:

Nonspecific
Loss of axons, hyalinization of perineurium and of vessels in the endoneurium

Treatment:

Improve glycemic control
Foot care
 

Autonomic diabetic neuropathy:

Diagnosis:

Features of autonomic neuropathy and meeting criteria for diabetes mellitus

Clinical features:

Usual features of autonomic neuropathy
 

Compression neuropathies:

Diagnosis:

Features of the compression mononeuropathy and meeting criteria for diabetes mellitus and exclusion of other causes

Clinical features:

Same as those caused by other local disease
 

Extraocular nerve palsies (III, IV and VI palsies):

Diagnosis:

Underlying features of the neuropathies

Clinical features:

Same as those caused by other local disease
 

Multifocal diabetic neuropathy a.k.a. Diabetic amyotrophy a.k.a. diabetic amyotrophy of Garland:

Diagnosis:

Features of lumbosacral plexopathy and meeting criteria for diabetes with exclusion of other causes

Clinical features:

Weight loss
Severe pain in femoral nerve and L4 distribution
Followed by weakness and wasting in the distribution of the femoral nerve and loss of Knee jerk
Also weakness in L2, L3 distribution occurs i.e. plexopathy

Pathology, nerve biopsy:

Multifocal loss of axons
Inflammation, lymphocytic of endoneurial and epineurial vessels
Immunohistochemsitry: CLA for lymphocytes
CSF: protein high
NCS: Asymmetrical, Axonal, multifocal,

Treatment:

Pain management
Control of glucose
 

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