Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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Diabetic Amyotrophy

⚡ Cardinal symptoms: abrupt onset of severe proximal leg pain (thigh, hip, or back), followed within weeks by progressive weakness and muscle wasting.

📖 About

Also called Bruns Garland syndrome.
A rare neurological complication of diabetes, usually in Type 2 diabetes and older adults.
Mainstay of management: improved glycaemic control and physiotherapy.

📊 Epidemiology

~1.1% of Type 2 diabetes patients.
~0.3% of Type 1 diabetes patients.

🧬 Aetiology / Pathophysiology

Multifactorial: autoimmunity, metabolic derangements, microvascular insufficiency, oxidative stress, and growth factor deficiency.
Endoneurial microvasculitis and impaired perfusion → axonal damage.
Immune-mediated nerve injury in a metabolically stressed, genetically predisposed host.

🩺 Clinical Features

Typical age: >50 years.
💥 Severe unilateral thigh/hip pain → spreads bilaterally over weeks.
Asymmetrical proximal weakness (quadriceps, hip adductors, iliopsoas) + wasting.
🔥 Pain precedes weakness, often disabling.
May have mild sensory loss (coexisting diabetic peripheral neuropathy).
Absent knee-jerk reflexes; ankle jerks preserved unless distal polyneuropathy coexists.
Recovery: slow, often incomplete; course lasts up to 3 years.

🧾 Differential Diagnosis

Cauda equina syndrome.
Guillain-Barré syndrome (AIDP).
Spinal canal stenosis.
Neoplastic lumbosacral plexopathy.
Chronic inflammatory demyelinating polyneuropathy (CIDP).

🔎 Investigations

🧪 Blood glucose (may be presenting feature of diabetes).
📉 Haematinics: rule out B12/folate deficiency.
💉 Lumbar puncture if AIDP/CIDP suspected → CSF protein may be raised.
⚡ EMG & nerve conduction studies → axonal damage (or demyelination if CIDP overlap).
🖥️ MRI lumbosacral spine → exclude structural causes (disc, stenosis, tumour).

🛠️ Management

🔍 Recognise: may be first sign of undiagnosed diabetes.
🧩 Classification: – Axonal type → supportive care. – Demyelinating type (CIDP overlap) → may respond to IVIG, plasmapheresis, steroids, immunosuppressants.
💉 Strict glycaemic control (often with insulin initially).
🏋️ Aggressive physiotherapy & mobility support.
💊 Pain management: TCAs, gabapentinoids, analgesics.
👩‍⚕️ Neurology referral for diagnostic clarification and advanced therapies.

📚 References

Diabetic Amyotrophy: From the Basics to the Bedside

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