37 results match your criteria: "Diabetic Lumbosacral Plexopathy"

Article Synopsis
  • A case study describes a patient with uncontrolled diabetes who initially showed symptoms resembling diabetic lumbosacral radiculoplexus neuropathy (DLRPN), including lower limb pain, weakness, and sensory loss.
  • The patient was also found to be HIV-1 positive, prompting further diagnostic testing that revealed abnormal results in cerebrospinal fluid (CSF) and a nerve biopsy that suggested an alternative diagnosis.
  • The study emphasizes the need for thorough diagnostic evaluations in cases where atypical presentations of neuropathy occur, especially when multiple medical conditions are present.
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Objectives: Limitations in human cognition commonly result in clinical reasoning failures that can lead to diagnostic errors. A metacognitive structured reflection on what clinical findings fit and/or do not fit with a diagnosis, as well as how discordance of data can help advance the reasoning process, may reduce such errors.

Case Presentation: A 60-year-old woman with Hashimoto thyroiditis, diabetes, and generalized anxiety disorder presented with diffuse arthralgias and myalgias.

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Article Synopsis
  • Intravenous immune globulin (IVIG) is a therapy being used for neuromuscular disorders, but there is limited high-quality evidence for many specific diseases, leading to the AANEM's 2009 consensus on its use.
  • Since then, new research and FDA approvals have prompted an update to the guidelines, categorizing recommendations from Class I (strong evidence) to Class IV (weak evidence).
  • IVIG is strongly recommended for conditions like chronic inflammatory demyelinating polyneuropathy and Guillain-Barré Syndrome but not recommended for others like inclusion body myositis, with uncertain support for various other disorders.
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A Convoluted Picture of Diabetic Myonecrosis.

WMJ

May 2023

Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.

Introduction: A patient with well-controlled type 2 diabetes was found to have diabetic myonecrosis, a rare condition associated with poorly controlled type 2 diabetes. Diagnosis was masked by concern for lumbosacral plexopathy from a history of spinal cord infarct.

Case Presentation: A 49-year-old African American woman with type 2 diabetes and paraplegia secondary to spinal cord infarct presented to the emergency department with left leg swelling and weakness from her hip to toes.

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Lumbosacral plexopathy (LSP) encompasses a group of disorders affecting post-ganglionic fibers derived from the L1-S4 roots. The differential diagnosis is challenging and includes other neuropathies of medullary, radicular, or peripheral origin. Defining the etiology is equally crucial, as LSP management relies on its cause.

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Diabetic lumbosacral plexopathy: an unpredictable clinical entity.

Disabil Rehabil

August 2023

Department of Geriatrics and Rehabilitation Medicine, Bendigo Health, Bendigo, Australia.

Purpose: Diabetic plexopathy is among the most unusual and disabling complication type 2 diabetic mellitus (T2DM) causing major suffering among affected individuals. The clinical presentation includes asymmetric muscle atrophy, weakness, and pain, typically associated with sudden weight loss. In part due to its rarity, this condition can be easily missed with serious consequences including potentially fatal complications.

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Introduction/aims: Recently, our group found an association between diabetes mellitus (DM) and lumbosacral radiculoplexus neuropathy (LRPN) in Olmsted County, Minnesota; we found a higher risk (odds ratio [OR], 7.91) for developing LRPN in diabetic compared with nondiabetic patients. However, the influence of other comorbidities and anthropomorphic variables was not studied.

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Lumbosacral Radiculoplexus Neuropathy: Neurologic Outcomes and Survival in a Population-Based Study.

Neurology

April 2021

From the Departments of Neurology (M.V.P., R.S.L., P.J.D., P.J.B.D.), Radiology (B.M.H.), and Biomedical Statistics and Informatics (P.T.), Mayo Clinic, Rochester, MN; and Department of Neurology, National Neuroscience Institute (P.-S.N.), Singapore.

Objective: To determine whether patients in the community with lumbosacral radiculoplexus neuropathy (LRPN) have milder neuropathy than referral patients, we characterized the outcomes and survival of population-based compared to referral-based LRPN cohorts.

Background: Previously, we found that the incidence of LRPN is 4.16/100,000/y, a frequency greater than other inflammatory neuropathies.

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Lumbosacral plexopathy (LSP) is a rare entity characterized by acute onset of pain followed by sensory and motor deficits, reflex changes and muscle atrophy. The diagnosis is based on clinical and EMG findings. LSP can result from pelvic tumors, infections, trauma, abdominopelvic or spinal surgery, radiation, intravenous drug abuse, diabetic neuropathy, vasculitis or maybe idiopathic.

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Use of MRI in diabetic lumbosacral radiculoplexus neuropathy: case report and review of the literature.

Acta Neurochir (Wien)

November 2018

Department of Neurosurgery, The George Washington University, 2150 Pennsylvania Avenue, NW, Suite 7-412, Washington, DC, 20037, USA.

Diabetic lumbosacral radiculoplexus neuropathy is often confused with radiculopathy in the context of spinal degenerative disc disease including spinal stenosis. Accuracy in diagnosis may prevent unnecessary interventional procedures including selective nerve root blocks or epidural steroid injections or even surgery in selected cases. Our patient with known diabetes and lumbar disc disease presented with acute onset of pain in L5-S1 distribution of the left lower extremity.

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Article Synopsis
  • * The patient exhibited signs consistent with diabetic neuropathy, including high fasting glucose and neurogenic changes on electromyography, which were linked to the observed muscle changes.
  • * MRI plays a critical role in diagnosing denervation pseudohypertrophy, aiding in distinguishing it from similar conditions and guiding subsequent treatment strategies based on the underlying cause.
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Immunotherapy for diabetic amyotrophy.

Cochrane Database Syst Rev

July 2017

Division of Neurology, National University Hospital, 1E, Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, Singapore, 119228.

Background: People with diabetes mellitus (DM) sometimes present with acute or subacute, progressive, asymmetrical pain and weakness of the proximal lower limb muscles. The various names for the condition include diabetic amyotrophy, diabetic lumbosacral radiculoplexus neuropathies, diabetic femoral neuropathy or Bruns-Garland syndrome. Some studies suggest that diabetic amyotrophy may be an immune-mediated inflammatory microvasculitis causing ischaemic damage of the nerves.

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Gluteal Necrosis and Lumbosacral Plexopathy in a Diabetic Patient after Renal Transplantation.

Case Rep Urol

January 2016

Nephrology Department, Shahid Modarres Hospital, Shahid Beheshti Medical University, Saadat Abad, Tehran 1998734383, Iran.

A 34-year-old diabetic patient underwent a renal transplant which was complicated by right side lower extremity paresis and numbness with gluteal necrosis. The main reason was ligation of internal iliac artery of the same side as a result of extensive microvascular obstruction due to severe atheromatous plaque. This is a rare complication which is mostly reported in aneurysmal patients after bypass surgery.

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Purpose Of Review: This article provides an up-to-date review of the clinical features and pathogenesis of different types of lumbosacral plexopathy and a clinical approach to their evaluation and management. Often, the pathologic involvement is not limited to the plexus and also involves the root and nerve levels. These conditions are called lumbosacral radiculoplexus neuropathies.

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Immunotherapy for idiopathic lumbosacral plexopathy.

Cochrane Database Syst Rev

December 2013

Department of Neurology, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen, Netherlands, 6500 HB.

Background: Idiopathic lumbosacral plexopathy (ILSP), also called lumbosacral plexitis or non-diabetic lumbosacral (radiculo)plexus neuropathy is a rare clinical entity. The core features are (sub)acute, severe, asymmetrical leg pain, followed by asymmetrical multifocal weakness and atrophy in the subsequent weeks or months. Sensory symptoms include paresthesias, hypesthesia, allodynia, and autonomic dysfunction.

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Diagnosis of brachial and lumbosacral plexus lesions.

Handb Clin Neurol

April 2014

Department of Neurology and Clinical Neurophysiology, Radboud University Nijmegen Medical Centre, The Netherlands. Electronic address:

To most doctors, brachial and lumbosacral plexopathies are known as difficult disorders, because of their complicated anatomy and relatively rare occurrence. Both the brachial, lumbar, and sacral plexuses are extensive PNS structures stretching from the neck to axillary region and running in the paraspinal lumbar and pelvic region, containing 100000-200000 axons with 12-15 major terminal branches supplying almost 50 muscles in each limb. The most difficult part in diagnosing a plexopathy is probably that it requires an adequate amount of clinical suspicion combined with a thorough anatomical knowledge of the PNS and a meticulous clinical examination.

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Electrodiagnostic testing in lumbosacral plexopathies.

Phys Med Rehabil Clin N Am

February 2013

Department of Neurology, Mayo Clinic Rochester, Rochester, MN 55905, USA.

Patients presumed to have lower limb symptoms localizing to the lumbar or lumbosacral plexus require rigorous electrophysiological evaluation. Entities that cause lumbosacral plexopathies may be patchy, asymmetrical and more diffuse than initially suspected. As a result, bilateral nerve conduction studies and needle examination outside those routinely tested and clinically affected may be needed to document the extent of involvement including needle examination of the thoracic paraspinals and consideration of upper limb studies.

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Diabetic lumbosacral radiculoplexus neuropathy is a subacute painful, asymmetrical lower limb neuropathy due to ischaemic injury and microvasculitis. The occurrence of a cervical diabetic radiculoplexus neuropathy has been postulated. Our objective was to characterize the clinical features and pathological alterations of diabetic cervical radiculoplexus neuropathy, to see if they are similar to diabetic lumbosacral radiculoplexus neuropathy and due to ischaemic injury and microvasculitis.

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Immunotherapy for diabetic amyotrophy.

Cochrane Database Syst Rev

June 2012

Division of Neurology, National University Hospital, Singapore, Singapore.

Background: People with diabetes mellitus (DM) sometimes present with acute or subacute, progressive, asymmetrical pain and weakness of the proximal lower limb muscles. The various names for the condition include diabetic amyotrophy or diabetic lumbosacral radiculoplexus neuropathies. Some studies suggest that it may be due to immune-mediated inflammatory microvasculitis causing ischaemic damage of the nerves.

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[Normal tissue tolerance to external beam radiation therapy: peripheral nerves].

Cancer Radiother

July 2010

Département de Radiothérapie, Institut Bergonié, Centre Régional de Lutte Contre le Cancer, 229 Cours de l'Argonne, 33076 Bordeaux cedex, France.

Plexopathies and peripheral neuropathies appear progressively and with several years delay after radiotherapy. These lesions are observed principally after three clinical situations: supraclavicular and axillar irradiations for breast cancer, pelvic irradiations for various pathologies and limb irradiations for soft tissue sarcomas. Peripheral nerves and plexus (brachial and lumbosacral) are described as serial structures and are supposed to receive less than a given maximum dose linked to the occurrence of late injury.

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Immunotherapy for diabetic amyotrophy.

Cochrane Database Syst Rev

July 2009

Division of Neurology, National University Hospital, 5, Lower Kent Ridge Road, Singapore, Singapore, 119074.

Background: People with diabetes mellitus (DM) sometimes present with acute or subacute, progressive, asymmetrical pain and weakness of the proximal lower limb muscles. The various names for the condition include diabetic amyotrophy, or diabetic lumbosacral radiculoplexus neuropathies. Some studies suggest that it may be due to immune-mediated inflammatory microvasculitis causing ischaemic damage of the nerves.

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Diabetic and non-diabetic lumbosacral radiculoplexus neuropathy.

Neurol India

March 2009

Departments of Neurology, Emory University, Atlanta, Georgia and University of Minnesota, Minneapolis, Minnesota 55455, USA.

Background: Lumbosacral radiculoplexus neuropathy (LRPN) originally described in diabetic patients is a distinct clinical condition characterized by debilitating pain, weakness and atrophy most commonly affecting the proximal thigh muscles asymmetrically. The syndrome is usually monophasic and preceded by significant weight loss (at least more than 10 lbs). Though a self-limited condition, recovery is gradual with some residual weakness.

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[Idiopathic lumbosacral plexopathy].

Presse Med

July 2005

Laboratoire d'Electromyographie, Hôpital de la Salpêtriere, Paris.

Introduction: Lumbosacral plexopathy is the equivalent in the lower limbs of neuralgic amyotrophy (also known as Parsonage-Turner syndrome) in the upper limbs. It is well-known in patients with diabetes mellitus, when it is known as Bruns-Garland syndrome.

Case: We report the case of a 47-year-old woman who developed a unilateral neuropathy of the leg, neither radicular nor truncal in origin.

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