Microvasculitis in diabetic lumbosacral radiculoplexus neuropathy.
We present a case of a 60-year-old man with mild type 2 diabetes mellitus and step-wise progression of bilateral lower limb weakness, numbness, and pain over a 1-year period. At the time of evaluation, he used a walker. He had elevated cerebrospinal fluid protein, abnormal cooling and heat-pain thresholds on quantitative sensory testing, and nerve conduction studies/electromyography consistent with bilateral lumbosacral radiculoplexus neuropathies. Because it was not clear whether the disease was still active, a right superficial peroneal nerve biopsy was performed and showed evidence of active axonal degeneration, ischemic injury, and microvasculitis. On the basis of these results, the patient was diagnosed with diabetic lumbosacral radiculoplexus neuropathy and was treated with weekly intravenous methylprednisolone with marked improvement of neurologic symptoms and signs. This case illustrates the typical clinical, electrophysiologic, and pathologic features of diabetic lumbosacral radiculoplexus neuropathy and the utility of nerve biopsy to judge ongoing disease activity.
Tracy
Jennifer A
JA
Peripheral Neuropathy Research Laboratory, Mayo Clinic, Rochester, MN 55905, USA.
Engelstad
JaNean K
JK
Dyck
P James B
PJ
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001160:Arterioles / Q000473:pathology*; D001706:Biopsy; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000473:pathology* / Q000503:physiopathology*; D004568:Electrodiagnosis; D006801:Humans; D008160:Lumbosacral Plexus / Q000098:blood supply / Q000473:pathology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology / Q000503:physiopathology; D009431:Neural Conduction / Q000502:physiology; D010543:Peroneal Nerve / Q000473:pathology; D012678:Sensation Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome; D014657:Vasculitis / Q000473:pathology* / Q000503:physiopathology
D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone