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Diabetic Amyotrophy

Diabetic amyotrophy presents with severe asymmetric pain in the leg, thigh or buttock, followed by weakness, atrophy, and weight loss in some cases.¹ These symptoms become more symmetrical over time.¹ It occurs in 1% of type II diabetics.¹ Pathogenesis involves microvasculitic ischemic injury to the lumbosacral nerve roots and plexus.² In one third of cases, the condition also spreads to the cervicothoracic region.¹ CSF analysis shows elevated protein without pleocytosis.¹ The differential diagnosis includes lumbosacral nerve root compression, neuropathies such as chronic inflammatory demyelinating polyradiculoneuropathy and muscular pathologies like diabetic muscle infarction. Spinal imaging with neurophysiologic testing helps narrow the diagnosis. In addition, given the weight loss, pelvic imaging to rule out infiltrative malignancy is imperative.¹ Management involves pain control and physiotherapy. Immunosuppression has not yet shown effectiveness.³ Most patients improve within months; however, residual weakness may persist.

References:

1. Llewelyn D, Llewelyn JG. Diabetic amyotrophy: a painful radiculoplexus neuropathy. Pract Neurol. 2019;19(2):164-167; doi:10.1136/practneurol-2018-002105
2. Dyck PJ, Norell JE, Dyck PJ. Microvasculitis and ischemia in diabetic lumbosacral radiculoplexus neuropathy. Neurology. 1999;53(9):2113-21; doi:10.1212/wnl.53.9.2113
3. Chan YC, Lo YL, Chan ES. Immunotherapy for diabetic amyotrophy. Cochrane Database Syst Rev. 2017;7(7):CD006521; doi:10.1002/14651858.CD006521.pub4

Submitted by: Ibrahim Alkhodair, King Saud University (medical graduate), Neurology Rotation, Houston Medical Clerkship, Sugar Land, Texas

Ibrahim Alkhodair reports no disclosures.