Diabetic radiculoplexopathy is commonly viewed as a condition affecting the lower extremities. The core features are (sub)acute, severe, asymmetrical leg pain, followed by asymmetrical multifocal weakness and atrophy in the subsequent weeks or months. We analyzed retrospectively the medical records, electrophysiological reports of the patients, literatures on the anatomy of lumbar plexus and other literature reporting similar complications. He was diagnosed with diabetes mellitus eight years ago and his blood sugar level was not strictly controlled with insulin. Patients often report that after resting on a limb in an awkward position, the resulting weakness and dysesthesias last weeks to months, rather than seconds to minutes. We report a case of a 22 year old man with a history of schizophrenia who was admitted with neuroleptic malignant syndrome requiring mechanical ventilation. Biopsies of distal cutaneous nerve segments have shown features suggestive of an inflammatory microvasculitis causing ischemic damage of the nerves.
Rather than an upper trunk brachial plexopathy, the electrodiagnostic pattern in neuralgic amyotrophy is one of multifocal peripheral nerve involvement, with a predilection for motor nerves innervated by the upper trunk, as well as the anterior interosseous nerve, long thoracic nerve, and proximal median nerve. This makes that INA is part of the differential diagnosis in a child with a painful lower limb. Gabapentin is one of the medications which is used for nerve pain. Neurophysiology showed axonal neuropathy (80/80) with paraspinal denervation (21/65), and abnormal autonomic (23/24) and sensory testing (10/13). Appreciation of the clinical spectrum and context of diabetic amyotrophy should facilitate its differentiation from other disorders, including other forms of diabetic neuropathy. Magnetic resonance imaging showed brachial plexus abnormality in all (38/38). Nerve biopsies (11 upper and 11 lower limbs) showed ischaemic injury (axonal degeneration, multifocal fibre loss 15/22, focal perineurial thickening 16/22, injury neuroma 5/22) and increased inflammation (epineural perivascular inflammation 22/22, haemosiderin deposition 6/22, vessel wall inflammation 14/22 and microvasculitis 5/22).
Men are affected more often than women.