Diabetic amyotrophy is a complication of diabetes that affects the lumbosacral plexus, typically predominantly either the femoral nerve or the three roots that contribute to the femoral nerve. It is also known as neuralgic amyotrophy, diabetic amyotrophy of Garland, Bruns-Garland syndrome, and diabetic lumbosacral plexus radiculoneuropathy.
Typically seen in older diabetic patients. The diabetes is commonly relatively recently diagnosed or well controlled.
Typically the femoral nerve is affected. In other cases there are lesions of L2, L3, and L4 nerve roots rather than the femoral nerve. In this situation there is a more widespread motor deficit and wasting, with involvement of the hip flexors and adductor muscles.
The onset is typically characterised by severe pain in the low back, down the anterior thigh, that often radiates down to the medial aspect of the leg and ankle. Weakness is typically proximal and generally occurs after a few days to weeks after the pain and can be severe. The patient will usually have had rapid weight loss and poor health in the weeks prior to symptoms. After a few days, the pain improves and the patient suddenly has rapid muscle wasting with weakness of quadriceps and is unable to walk.
Electrophysiology is supportive
In non-diabetic consider idiopathic lumbosacral plexopathy, neoplastic infiltration of the lumbosacral plexus, lumbosacral plexus ischaemia, mass effect, sarcoidosis, vasculitis, and infection.
Treatment is supportive. There is usually eventual improvement from 6 months, but it can take up to two years for full recovery. Most patients will have some remaining neuropathic pain and motor deficits. 10% are wheelchair bound at 2 years.
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