Diabetic Lumbosacral Radiculoplexopathy DLSRP

Diabetic Lumbosacral Radiculoplexopathy DLSRP

www.rrnmf.com Diabetic Lumbosacral Radiculoplexopathy DLSRP Richard J. Barohn, MD Chair, Department of Neurology Gertrude and Dewey Ziegler Professor of Neurology University Distinguished Professor Vice Chancellor for Research University of Kansas Medical Center Kansas City, KS Case History

65 F DM 2 yrs., oral Rx Tingling toes x 1 yr. Now CC leg pain/weak ? more tingling 6 mos pain/wk left leg pain lumbar to hip/post-thigh 2 mos similar symptoms right leg MRI DJD L4/5 laminectomy Post-op worse/cant walk 20 lb weight loss over 6 mos Gabapentin/TCA no help Case PE

Quad atrophy, L > R Arm strength NL R L HF/Abd 3- 2 KE/KF

4 3 AD/E/I 3- 0 DTR NL arms/0 legs Sens No vib toes/prop NL Dec touch/pin to ankles

Case Question 1 What pattern of neuropathy does this patient have? a. Symmetric proximal and distal weakness with sensory loss (NP1) b. Symmetric distal sensory loss with or without weakness (NP2) c. Asymmetric distal weakness with sensory loss (NP3) d. Asymmetric proximal and distal weakness with sensory loss (NP4) e. Asymmetric distal weakness without sensory loss (NP5) Case

Question 2 What is the diagnosis? a) Vasculitis neuropathy b) Lumbar stenosis with radiculopathy c) Diabetic lumbosacral radiculoplexopathy d) MADSAM e) Arachnoiditis Answer: c. Diabetic lumbosacral radiculoplexopathy Case Labs Random glucose 120 200 HgA1C - 6.5 NCS: L PER/TIB NR

R PER Amp 0.5/LAT 6.6/CV 34 R TIB Amp 11/LAT 6.7/CV 35 Sural NR Bilat UE NCS NL EMG Fibs/neurogenic MUPS Prox/Distal LE & LS paraspinous Case Question 3 What is the treatment? a) IVIg b) Cyclophosphamide c) Narcotics for pain and physical therapy

d) Plasmapheresis e) Oral prednisone Answer: c. Narcotics for pain and physical therapy Case Course Rx Fentanyl patch and oxycodone to break pain cycle Pain improved Begin vigorous PT In 2 weeks beginning to walk Slow improvement over next 6 months Diabetic Lumbosacral Radiculoplexopathy DLSRP Other Names:

Proximal diabetic neuropathy Ischemic mononeuropathy multiplex Femoral or fem-sciatic neurop Diabetic amyotrophy Bruns-Garland Syndrome Patients are usually:

> age 50; NIDDM 1/3 on oral meds 1/3 on insulin 1/3 new onset DM Glucose often inc, but may be NL DLSRP Typical Clinical Presentation

Pain - Back, hip, thigh Initially overshadows weakness Weakness - prox + distal leg after pain Spreads to opposite side within days or weeks At least 25%, perhaps much more Latency - days to months Numb/Tingling c/o - 50%

Distal Sens Loss (DSPN) Knee + Ankle Reflex Loss Wt Loss in 1/3 DLSRP Lab NCS - DSPN EMG - Profuse fibs Prox/Distal/Paraspinous CSF - Often prot 60-100 mg/dl (up to 400) ESR NL or , usually < 50 Sural Nerve Bx - Asymmetric fiber loss Axonal degen Occas slight perivascular inflammation

DLSRP Course Initially worsens in gradual or step-wise manner Eventually stabilizes, plateaus, and improves Worsening phase lasts weeks to months (up to 18 mo) Arch Neurol 1991;48:1130-1135. Diabetic Lumbosacral Radiculoplexopathy DLSRP The Neurologists Pattern Only a neurologist makes Dx

Only a neurologist can give best recommendations/prognosis

Recently Viewed Presentations

  • ENGLISH QUIZ - WordPress.com

    ENGLISH QUIZ - WordPress.com

    Religious allusion (a reference to a well known religious story) Shared lines & broken meter (characters sharing the meter of the line and deliberately breaking the rhythm) Personification (giving a non-human thing human qualities - clue 'murder')
  • The National Policy - ROOM 112

    The National Policy - ROOM 112

    The goals of the National Policy . The National Policy is a protectionist policy that aims at protecting the Canadian economy from American competition. The Three goals of the National Policy: Increased customs duties: impose protectionist tariffs in order to...
  • The Archetype of the Wasteland - Northern Highlands

    The Archetype of the Wasteland - Northern Highlands

    He began to die." - from "The Tale of the Fisher King" (LaGravenese) Characteristics of the myth The King responsible for the future of the kingdom worldly wealth and power The Wasteland Sterility Symbolism/metaphor in modern texts The "Dead Marshes"...
  • CSCI5582L10


    Artificial Intelligence Lecture 11 Jim Martin Today 10/3 Review Model Checking/Wumpus CNF WalkSat Break Start on FOL Review Propositional logic provides Propositions that have Truth values and Logical connectives that allow a Compositional Semantics and Inference Models Models are formally...
  • The Urinary System - Yola

    The Urinary System - Yola

    When reaches a certain point, triggers stretch receptors. Where have we seen these before? Muscle contraction When trigger point is reached, spinal reflex sends impulse to bladder muscles Muscles in bladder contract and give sensation of needing to urinate. Sphincter...
  • Data Structures for Strings Chapter 8 Introduction  Numbers

    Data Structures for Strings Chapter 8 Introduction Numbers

    8.1 Tries & Compressed Tries. Tries. The basic tool for string data structures, similar in role to the balanced binary search tree, is called "trie" Derive from "retrieval." (Pronounced either try or tree) In this tree, the nodes are not...
  • Pulsed EM Field Response of a Thin, High-contrast Layered ...

    Pulsed EM Field Response of a Thin, High-contrast Layered ...

    OUTLINE. 1. Significance and History. 2. Quantum Electrodynamics. 3. Spontaneous Emission, Local Density of States, and Green's Tensor . 4. Graphene Plasmonics to Control the Local Density of States
  • Asia - robeson.k12.nc.us

    Asia - robeson.k12.nc.us

    In 1279, Kublai Khan, the grandson of Genghis Khan, conquered the Song dynasty and established the Yuan dynasty in China. Kublai Khan established his capital at Khanbalik, in what is present-day Beijing. While the Mongols were successful in ruling China,...