Diabetic amyotrophy--a more diffuse process than clinically suspected
Donovan, W.H.; Sumi, S.M.
Archives of Physical Medicine and Rehabilitation 57(8): 397-403
1976
ISSN/ISBN: 0003-9993 PMID: 949238 Document Number: 104482
There is little evidence to support the impression that the primary pathology lies within the spinal cord, at the myoneural junction or in the muscle fiber itself. This disorder is probably a discrete neuropathic process affecting motor nerves preferentially and is not necessarily a manifestation of the diffuse peripheral neuropathy more commonly found in diabetic patients. Although this distal polyneuropathy may be found in patients with diabetic amyotrophy, the latter can occur independently. Segmental demyelination and Wallerian degeneration were described in patients with diabetic amyotrophy, but these patients usually had evidence of peripheral neuropathy as well; these changes were usually found in more distal nerves. Since the electrophysiologic and biopsy findings in the patients support a neuropathic etiology, diabetic amyotrophy is apparently a form of mononeuropathy multiplex involving the femoral nerves in all cases and other nerves to proximal muscles such as the obturator nerve, superior gluteal nerve, and segmental lumbar and thoracic spinal nerves in many cases as well. The relatively rapid onset and often good recovery suggest a vascular etiology with infarction as was postulated for other cases of diabetic mononeuropathy multiplex and cranial neuropathies. The role which metabolic factors play in this disorder remains unclear, however the rapidity of recovery following regulations of the blood glucose argues for some relationship.