Pattern of myelinated fibre loss in the sural nerve in neuropathy related to type 1 (insulin-dependent) diabetes.
Sural nerve biopsies were obtained from 17 diabetic patients with neuropathy. All patients except three had both a symmetric distal sensory and autonomic polyneuropathy related to Type 1 (insulin-dependent) diabetes mellitus; 3 patients had a purely sensory polyneuropathy. Mean age was 34.5 years (range 18-53 years). The biopsies were compared with specimens from an age-matched control series. Myelinated fibre loss in the diabetic nerves was found to be nonuniform. Although patchy fibre loss has been considered to favour a vascular basis, an identical pattern of nonuniform loss was observed in a series of sural nerve biopsies from patients with Type I hereditary motor and sensory neuropathy, a subgroup within the spectrum of peroneal muscular atrophy, mainly of autosomal dominant inheritance, and a condition in which a vascular causation can be discounted. Possible reasons for nonuniform fibre loss other than vascular disease are discussed.
Llewelyn
J G
JG
Department of Neurological Science, Royal Free Hospital School of Medicine, London, UK.
Thomas
P K
PK
Gilbey
S G
SG
Watkins
P J
PJ
Muddle
J R
JR
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000473:pathology*; D003929:Diabetic Neuropathies / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000166:cytology*; D012016:Reference Values; D013127:Spinal Nerves / Q000473:pathology*; D013497:Sural Nerve / Q000166:cytology / Q000473:pathology*