Mayo Clinic ProceedingsSubacute Diabetic Proximal Neuropathy
Section snippets
METHODS
We conducted a retrospective review of the medical records of all patients with diabetes who underwent autonomic function and electromyographic (EMG) testing at Mayo Clinic Rochester during the 12-year period from 1983 to 1995. We also included patients with diabetes who had subacute motor weakness and a diagnosis of diabetic proximal neuropathy, polyradiculoneuropathy, or chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and were examined by one of the authors. Overall, medical
RESULTS
Clinical Profile.—Clinical characteristics of the 44 study patients are summarized in Table 1. Of the 25 male and 19 female patients, all but 4 had non-insulin-dependent diabetes mellitus (NIDDM). The mean duration of diabetes was about 11 years, and control of diabetes was variable. Fasting plasma glucose values ranged from 74 to 310 mg/dL (median value, 151.5; 25th percentile, 113; and 75th percentile, 199). Glycosylated hemoglobin ranged from 4.5 to 16.2% (median, 9.05; 25th percentile,
ILLUSTRATIVE CASES
Patients with subacute diabetic proximal neuropathy have a spectrum of manifestations and responses to treatment. Four cases are presented to illustrate this variety.
Case 32.—A 56-year-old man with diabetes had a 6month history of progressive lower extremity weakness with a subacute progression before undergoing assessment at Mayo Clinic Rochester. Clinical examination confirmed severe weakness of the lower extremities and inability to walk. Generalized areflexia and minimal sensory loss were
DISCUSSION
We describe a group of 44 patients encountered at Mayo Clinic Rochester during a 12-year period who fulfilled the clinical criteria of subacute diabetic proximal neuropathy. In our series, these patients had bilateral, predominantly but not exclusively symmetric proximal lower extremity weakness, in conjunction with reduced or absent reflexes, increased CSF protein concentration, and electrophysiologic evidence of a polyradiculopathy. The initial symptom in most patients was weakness, although
CONCLUSION
The pattern of subacute bilateral diabetic proximal neuropathy is sufficiently distinctive to merit definition. We suggest the following diagnostic criteria: (1) proximal weakness of subacute evolution (during a period of 1 to 3 months); (2) bilateral involvement, or unilateral weakness followed by involvement of the opposite limb within 2 months; (3) reduced or absent knee tendon reflexes; (4) increased CSF protein concentration; (5) progression for at least 2 months; and (6)
ACKNOWLEDGMENT
We acknowledge the excellent support provided by the following personnel: Tonette L. Opfer-Gehrking generated CASS scores on all the autonomic studies and Anita D. Zeller provided secretarial support.
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This study was supported in part by Grants NS 32352 POI, NS 22352, and NS 30534 from the National Institute of Neurological and Communicative Disorders and Stroke, a grant from the National Aeronautics and Space Administration, and the Mayo Foundation.