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This form of neuropathy is often referred to as diabetic amyotrophy, a term that draws attention to one facet of the syndrome but is otherwise uninformative Garland s name has also been attached to this diabetic lumbar radiculoplexopathy based on his early and thorough report (but he mistakenly attributed the condition to a spinal cord lesion) A potentially vasculitic mechanism demonstrated by Raff and colleagues has been supported by PJB Dyck and others A vasculopathy involving vaso nervorum, the traditional explanation, seems more likely to us Clinical experience has shown that an identical painful lumbofemoral neuropathy may develop in nondiabetics; possibly this form is also vasculopathic or vasculitic While lumbar disc herniation, retroperitoneal hematoma compressing upper lumbar roots, carcinomatous meningeal seeding, and neoplastic and sarcoid in ltration of the proximal lumbar plexus enter into the differential diagnosis, the diabetic type is usually so distinctive as to permit an early recognition on clinical grounds Also observed in diabetic patients is a syndrome of proximal symmetrical leg weakness, wasting, and re ex loss of more insidious onset and gradual evolution as discussed by Pascoe and colleagues The iliopsoas, quadriceps, and hamstrings are involved in varying degrees The muscles of the scapulae and upper limbs, usually the deltoid and triceps, are affected less frequently Pain is not a consistent feature, as it is in the acute asymmetrical type, and sensory changes, if present, are distal, symmetrical, and usually mild In this attempt to delineate two types of proximal diabetic neuropathy, it must be emphasized that there is an overlap between them and that distal parts of a limb may be involved to a lesser degree in both conditions and that the timing of evolution of symptoms varies Nor can the proximal and distal type be distinguished on pathologic or electrophysiologic grounds alone Whether they should even be considered as separate entities is not clear Well known to diabetologists is a syndrome of thoracoabdominal radiculopathy characterized by severe pain and dysesthesia Almost always the diabetes has been of long-standing (Kikta et al) The pain is distributed over one or several adjacent segments of the chest or abdomen; it may be unilateral or less often bilateral and tends to follow recent weight loss Super cial sensory loss can be detected over the involved area in most patients The pathology of this state is not known but it is also presumed to be an ischemic radiculopathy The EMG changes consist of brillations of the paraspinal and abdominal muscles in one or more adjacent myotomes, corresponding to the painful area With better control of the diabetes, or perhaps spontaneously, recovery eventually occurs but it may be protracted The differential diagnosis includes pre-eruptive herpes zoster, sarcoid in ltration of nerve roots, and the rare entity of thoracic disc rupture In all forms of diabetic polyneuropathy, the CSF protein may be elevated from 50 to 150 mg/dL and sometimes even higher The protein concentration is usually normal in cases of diabetic mononeuropathy (Whether a slight elevation of CSF protein, discovered incidentally, can be attributed to diabetes in the absence of a polyneuropathy is uncertain) In this type and the ones described further on, both type 1 and type 2 diabetic patients are susceptible, the duration of diabetes being a major factor Autonomic Neuropathy Symptoms of autonomic involvement include any combination of pupillary and lacrimal dysfunction, impairment of sweating and vascular re exes, nocturnal diarrhea, at-. how to create barcode in excel Barcode Excel Add-In TBarCode Office: Create Barcodes in Excel
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