Diabetic neuropathy part 2: proximal and asymmetric phenotypes

Abstract

Diabetic neuropathies consist of a variety of syndromes resulting from different types of damage to peripheral or cranial nerves. Although distal symmetric polyneuropathy is the most common type of diabetic neuropathy, many other subtypes have been defined since the 1800s, including proximal diabetic, truncal, cranial, median, and ulnar neuropathies. Various theories have been proposed for the pathogenesis of these neuropathies. The treatment of most requires tight and stable glycemic control. Spontaneous recovery is seen in most of these conditions with diabetic control. Immunotherapies have been tried in some of these conditions however are controversial.

Figure 1

From Barohn RJ et al The Bruns-Garland syndrome (diabetic amyotrophy): Revisited 100 years later. Arch Neurol 1991; 48:1130-1135.

Figure 2

Cross sections of sural nerve fascicles. 1μm thick. Non random fiber loss is more apparent and more severe in the left than in the right. From Barohn RJ et al The Bruns-Garland syndrome (diabetic amyotrophy): Revisited 100 years later. Arch Neurol 1991; 48:1130-1135.

Figure 3

From Barohn RJ et al. Case-of-the-month: Painful thigh mass in a young woman: diabetic muscle infarction. Muscle Nerve 1992;15:850-855.