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Weakness of unilateral lower limb s proximal muscle; diabetic amyotrophy coexisting with lumbar discopathy: Case report and review of the literature

Year 2014, Volume: 41 Issue: 3, 603 - 607, 01.09.2014
https://doi.org/10.5798/diclemedj.0921.2014.03.0484

Abstract

Diabetic amyotrophy is a relatively infrequent complication of diabetes mellitus is most often characterized by weakness of unilateral lower limb and pain. Clinical differentiation from lumbar disc herniation may be difficult. ıt was hereby presented; 64 year old male patient who has 15 year old history of diabetes mellitus and lumbar discopathy previously diagnosed. He had weakness of unilateral lower limb and pain. Patient was admitted right thigh pain and weakness of proximal lower limb muscle. The physical examination, magnetic resonance imaging and electromyographic examination of the patient was consistent with the diagnosis of diabetic amyotrophy. When diabetic amyotrophy and lumbar disc herniaton coexist as a pain source, which disease responsible from pain should be detected well and treatments should be arrenged according to responsible disease. Thus, unnecessary surgeries can be avoided.

References

  • Bhadada SK, Sahay RK, Jyotsna VP, et al. Diabetic Neuropathy: Current Concepts. J Indian Acad Clin Med 2001;2:306-317.
  • Ropper AH, Diabetic neuropathy In: Brown RH, editor. Adam’s and Victor’s Principles of Neurology, 8th ed, USA, CN: The McGraw Hill, 2006.p:1134-1136.
  • Said G. Focal and multifocal diabetic neuropathies. Arq Neurop- siquiatr 2007;65:1272-1278.
  • Cho KT, Kim NH. Diabetic amyotrophy coexisting with lumbar disk herniation and stenosis: a case report Surgical Neurology 2009;71:496–499.
  • Cinotti G, Postacchini F, Weinstein JN. Lumbar spinal stenosis and diabetes. Outcome of surgical decompression. J Bone Joint Surg Br 1994;76:215-219.
  • Dyck PJ, Windebank AJ. Diabetic and nondiabetic lumbosacral ra- diculoplexus neuropathies: new insights into pathophysiology and treatment. Muscle Nerve 2002;25:477-491.
  • Oh SJ. Nerve conduction studies In: Rampertab R, editor. Clinical electromyography. 2nd ed. Baltimore, CN: Williams and Wilkins; 1993. p:219.
  • Moore DC. Block of the sciatic and femoral nerves. In: Moore DC. editor. Regional block. 4th ed. Springfield: CN: Charles C. Thomas, 1965:281–288.
  • Sander HW, Chokroverty S. Diabetic amyotrophy: current concepts. Semin Neurol 1996;16:173-178.
  • Thomas PK. Classification, Differential Diagnosis, and Staging of Diabetic Peripheral Neuropathy. Diabetes 1997:46:54-57.
  • Çelik M, Barkut K, Pazarcı NK, et al. Karpal tünel sendromu klinik tanılı diabetic hastalarda elektrofizyolojik bulgular. İstanbul Tıp Fakültesi Dergisi 2006;69:70-74.
  • Said G, Goulon-Goeau C, Moulonguet A: Nerve biopsy findings in different patterns of proximal diabetic neuropathy. Ann Neurol 1994;35:559-569.
  • Samut G, Özdemir O. Coexistence of lumbar disc herniation and diabetic amyotrophy: A Case report. J PMR Sci 2014;17:42-45.
  • Lozeron P, Nahum L, Lacroix C, et al. Symptomatic diabetic and non-diabetic neuropathies in a series of 100 diabetic patients. J Neurol 2002;249:569–575.
  • Barohn RJ, Sahenk Z, Warmolts JR, et al. The Bruns-Garland syn- drome (diabetic amyotrophy). Arch Neuro 1990;48:1130.
  • Hirsh LF. Diabetic polyradiculopathy simulating lumbar disc dis- ease. Report of four cases. J Neurosurg 1984;60:183-186.
  • Naftulin S, Fast A, Thomas M. Diabetic lumbar radiculopathy: sci- atica without disc herniation. Spine 1993;18:2419-2422.
  • Boulton AJM, Malik RA. Diabetic neuropathy. Med Clin North Am 1998;82:909-929
  • Pourmand R. Diabetic neuropathy. Neurol Clin 1997;15:569-576.
  • Nacır B, Koç B, Genç H, et al. A Rare Complication of Diabetes Mellitus: Diabetic Amyotrophy. J PMR Sci 2009;12:129-132.
  • Krıvıckas LS. Electrodiagnosis in neuromuscular diseases. Phys Med Rehabil Clin N Am 2003;14:278.
  • Sakellaridis N. The influence of diabetes mellitus on lumbar inter- vertebral disc herniation. Surg Neurol 2006;66:152-154.
  • Arinzon Z, Adunsky A, Fidelman Z, et al. Outcomes of decompres- sion surgery for lumbar spinal stenosis in elderly diabetic patients. Eur Spine J 2004;13:32-37.
  • Vinik A. Diabetic neuropathy: pathogenesis and therapy. Am J Med 1999;107:17-26.
  • Chen S, Liao M, Li J, et al. The correlation between microves- sel pathological changes of the endplate and degeneration of the intervertebral disc in diabetic rats. Experımental And Therapeutıc Medıcıne 2013;5:711-717.
  • Jensen TS, Backonja MM, Hernández JS, et al. New perspectives on the management of diabetic peripheral neuropathic pain. Diab Vasc Dis Res 2006;3:108-119.
  • Ziegler D. Painful diabetic neuropathy: advantage of novel drugs over old drugs? Diabetes Care. 2009;32:414-419.
  • Wong MC, Chung JWY, Wong TKS. Effects of treatments for symptoms of painful diabetic neuropathy: systematic review. BMJ 2007;335:87-97.
  • Ziegler D, Ametov A, Barinov A, et al. Oral treatment with alpha- lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care 2006;29:2365–2370.
  • Freeman R, Durso-Decruz E, Emir B. Efficacy, Safety and tolerabil- ity of pregabalin treatment of painful diabetic peripheral neuropa- thy: findings from 7 randomized, controlled trials across a range of doses. Diabetes Care 2008;31:1448–1454.
  • Courtney AE, Mc Donnel GV, Patterson VH. Human immunglobu- lin for diabetic amyotrophy a promising prospect? Postgrad Med J 2001;77:326-328.
  • Levin M. Neurotherapeutics. Nerve blocks in the treatment of head- ache. 2010;7:197-203.
  • Airaksinen O, Herno A, Turunen V, et al. Surgical outcome of 438 patients treated surgically for lumbar spinal stenosis. Spine 1997;22:2278–2282.

Tek taraflı alt ekstremite proksimal kas güçsüzlüğü; diyabetik amiyotrofi ve lomber diskopati birlikteliği: Olgu sunumu ve literatür derlemesi

Year 2014, Volume: 41 Issue: 3, 603 - 607, 01.09.2014
https://doi.org/10.5798/diclemedj.0921.2014.03.0484

Abstract

Diyabetin nadir bir komplikasyonu olan diyabetik amiyotrofi genellikle tek taraflı alt ekstremitede proksimal kas güçsüzlüğü ve ağrı ile seyreder. Klinik olarak lomber diskopatiden ayırımı zor olabilir. Bu olguda daha önce lomber diskopati tanısı konmuş ve 15 yıllık diyabetes mellitusu olan erkek hasta sunulmuştur. Hasta sağ uyluk bölgesinde ağrı, sağ alt ekstemite kas güçsüzlüğü şikayeti polikliniğe başvurdu. Hastaya fizik muayene, manyetik rezonans görüntüleme ve elektrofizyolojik çalışmalar sonunda Diabetik amiyotrofi tanısı konulmuştur. Özellikle ağrı nedeni olarak lomber diskopti ve diyabetik amiyotrofi birlikteliğinde hastanın şikayetinin hangi hastalıktan kaynaklandığının iyi belirlenmesi ve tedavinin ona göre düzenlenmesi sağlanmalıdır. Böylece gereksiz cerrahi müdahaleden kaçınılmış olur.

References

  • Bhadada SK, Sahay RK, Jyotsna VP, et al. Diabetic Neuropathy: Current Concepts. J Indian Acad Clin Med 2001;2:306-317.
  • Ropper AH, Diabetic neuropathy In: Brown RH, editor. Adam’s and Victor’s Principles of Neurology, 8th ed, USA, CN: The McGraw Hill, 2006.p:1134-1136.
  • Said G. Focal and multifocal diabetic neuropathies. Arq Neurop- siquiatr 2007;65:1272-1278.
  • Cho KT, Kim NH. Diabetic amyotrophy coexisting with lumbar disk herniation and stenosis: a case report Surgical Neurology 2009;71:496–499.
  • Cinotti G, Postacchini F, Weinstein JN. Lumbar spinal stenosis and diabetes. Outcome of surgical decompression. J Bone Joint Surg Br 1994;76:215-219.
  • Dyck PJ, Windebank AJ. Diabetic and nondiabetic lumbosacral ra- diculoplexus neuropathies: new insights into pathophysiology and treatment. Muscle Nerve 2002;25:477-491.
  • Oh SJ. Nerve conduction studies In: Rampertab R, editor. Clinical electromyography. 2nd ed. Baltimore, CN: Williams and Wilkins; 1993. p:219.
  • Moore DC. Block of the sciatic and femoral nerves. In: Moore DC. editor. Regional block. 4th ed. Springfield: CN: Charles C. Thomas, 1965:281–288.
  • Sander HW, Chokroverty S. Diabetic amyotrophy: current concepts. Semin Neurol 1996;16:173-178.
  • Thomas PK. Classification, Differential Diagnosis, and Staging of Diabetic Peripheral Neuropathy. Diabetes 1997:46:54-57.
  • Çelik M, Barkut K, Pazarcı NK, et al. Karpal tünel sendromu klinik tanılı diabetic hastalarda elektrofizyolojik bulgular. İstanbul Tıp Fakültesi Dergisi 2006;69:70-74.
  • Said G, Goulon-Goeau C, Moulonguet A: Nerve biopsy findings in different patterns of proximal diabetic neuropathy. Ann Neurol 1994;35:559-569.
  • Samut G, Özdemir O. Coexistence of lumbar disc herniation and diabetic amyotrophy: A Case report. J PMR Sci 2014;17:42-45.
  • Lozeron P, Nahum L, Lacroix C, et al. Symptomatic diabetic and non-diabetic neuropathies in a series of 100 diabetic patients. J Neurol 2002;249:569–575.
  • Barohn RJ, Sahenk Z, Warmolts JR, et al. The Bruns-Garland syn- drome (diabetic amyotrophy). Arch Neuro 1990;48:1130.
  • Hirsh LF. Diabetic polyradiculopathy simulating lumbar disc dis- ease. Report of four cases. J Neurosurg 1984;60:183-186.
  • Naftulin S, Fast A, Thomas M. Diabetic lumbar radiculopathy: sci- atica without disc herniation. Spine 1993;18:2419-2422.
  • Boulton AJM, Malik RA. Diabetic neuropathy. Med Clin North Am 1998;82:909-929
  • Pourmand R. Diabetic neuropathy. Neurol Clin 1997;15:569-576.
  • Nacır B, Koç B, Genç H, et al. A Rare Complication of Diabetes Mellitus: Diabetic Amyotrophy. J PMR Sci 2009;12:129-132.
  • Krıvıckas LS. Electrodiagnosis in neuromuscular diseases. Phys Med Rehabil Clin N Am 2003;14:278.
  • Sakellaridis N. The influence of diabetes mellitus on lumbar inter- vertebral disc herniation. Surg Neurol 2006;66:152-154.
  • Arinzon Z, Adunsky A, Fidelman Z, et al. Outcomes of decompres- sion surgery for lumbar spinal stenosis in elderly diabetic patients. Eur Spine J 2004;13:32-37.
  • Vinik A. Diabetic neuropathy: pathogenesis and therapy. Am J Med 1999;107:17-26.
  • Chen S, Liao M, Li J, et al. The correlation between microves- sel pathological changes of the endplate and degeneration of the intervertebral disc in diabetic rats. Experımental And Therapeutıc Medıcıne 2013;5:711-717.
  • Jensen TS, Backonja MM, Hernández JS, et al. New perspectives on the management of diabetic peripheral neuropathic pain. Diab Vasc Dis Res 2006;3:108-119.
  • Ziegler D. Painful diabetic neuropathy: advantage of novel drugs over old drugs? Diabetes Care. 2009;32:414-419.
  • Wong MC, Chung JWY, Wong TKS. Effects of treatments for symptoms of painful diabetic neuropathy: systematic review. BMJ 2007;335:87-97.
  • Ziegler D, Ametov A, Barinov A, et al. Oral treatment with alpha- lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care 2006;29:2365–2370.
  • Freeman R, Durso-Decruz E, Emir B. Efficacy, Safety and tolerabil- ity of pregabalin treatment of painful diabetic peripheral neuropa- thy: findings from 7 randomized, controlled trials across a range of doses. Diabetes Care 2008;31:1448–1454.
  • Courtney AE, Mc Donnel GV, Patterson VH. Human immunglobu- lin for diabetic amyotrophy a promising prospect? Postgrad Med J 2001;77:326-328.
  • Levin M. Neurotherapeutics. Nerve blocks in the treatment of head- ache. 2010;7:197-203.
  • Airaksinen O, Herno A, Turunen V, et al. Surgical outcome of 438 patients treated surgically for lumbar spinal stenosis. Spine 1997;22:2278–2282.
There are 33 citations in total.

Details

Primary Language Turkish
Journal Section Case Reports
Authors

Emine Eda Kurt This is me

Hatice Rana Erdem This is me

Figen Tuncay This is me

Publication Date September 1, 2014
Submission Date March 1, 2015
Published in Issue Year 2014 Volume: 41 Issue: 3

Cite

APA Kurt, E. E., Erdem, H. R., & Tuncay, F. (2014). Tek taraflı alt ekstremite proksimal kas güçsüzlüğü; diyabetik amiyotrofi ve lomber diskopati birlikteliği: Olgu sunumu ve literatür derlemesi. Dicle Tıp Dergisi, 41(3), 603-607. https://doi.org/10.5798/diclemedj.0921.2014.03.0484
AMA Kurt EE, Erdem HR, Tuncay F. Tek taraflı alt ekstremite proksimal kas güçsüzlüğü; diyabetik amiyotrofi ve lomber diskopati birlikteliği: Olgu sunumu ve literatür derlemesi. diclemedj. September 2014;41(3):603-607. doi:10.5798/diclemedj.0921.2014.03.0484
Chicago Kurt, Emine Eda, Hatice Rana Erdem, and Figen Tuncay. “Tek Taraflı Alt Ekstremite Proksimal Kas güçsüzlüğü; Diyabetik Amiyotrofi Ve Lomber Diskopati birlikteliği: Olgu Sunumu Ve literatür Derlemesi”. Dicle Tıp Dergisi 41, no. 3 (September 2014): 603-7. https://doi.org/10.5798/diclemedj.0921.2014.03.0484.
EndNote Kurt EE, Erdem HR, Tuncay F (September 1, 2014) Tek taraflı alt ekstremite proksimal kas güçsüzlüğü; diyabetik amiyotrofi ve lomber diskopati birlikteliği: Olgu sunumu ve literatür derlemesi. Dicle Tıp Dergisi 41 3 603–607.
IEEE E. E. Kurt, H. R. Erdem, and F. Tuncay, “Tek taraflı alt ekstremite proksimal kas güçsüzlüğü; diyabetik amiyotrofi ve lomber diskopati birlikteliği: Olgu sunumu ve literatür derlemesi”, diclemedj, vol. 41, no. 3, pp. 603–607, 2014, doi: 10.5798/diclemedj.0921.2014.03.0484.
ISNAD Kurt, Emine Eda et al. “Tek Taraflı Alt Ekstremite Proksimal Kas güçsüzlüğü; Diyabetik Amiyotrofi Ve Lomber Diskopati birlikteliği: Olgu Sunumu Ve literatür Derlemesi”. Dicle Tıp Dergisi 41/3 (September 2014), 603-607. https://doi.org/10.5798/diclemedj.0921.2014.03.0484.
JAMA Kurt EE, Erdem HR, Tuncay F. Tek taraflı alt ekstremite proksimal kas güçsüzlüğü; diyabetik amiyotrofi ve lomber diskopati birlikteliği: Olgu sunumu ve literatür derlemesi. diclemedj. 2014;41:603–607.
MLA Kurt, Emine Eda et al. “Tek Taraflı Alt Ekstremite Proksimal Kas güçsüzlüğü; Diyabetik Amiyotrofi Ve Lomber Diskopati birlikteliği: Olgu Sunumu Ve literatür Derlemesi”. Dicle Tıp Dergisi, vol. 41, no. 3, 2014, pp. 603-7, doi:10.5798/diclemedj.0921.2014.03.0484.
Vancouver Kurt EE, Erdem HR, Tuncay F. Tek taraflı alt ekstremite proksimal kas güçsüzlüğü; diyabetik amiyotrofi ve lomber diskopati birlikteliği: Olgu sunumu ve literatür derlemesi. diclemedj. 2014;41(3):603-7.