Abstract
Objective: We describe a patient with diabetic amyotrophy (radiculoplexopathy) that presented initially as isolated L5 radiculopathy.
Background Diabetic amyotrophy is characterized by severe pain followed by weakness and wasting of pelvifemoral muscles, either unilaterally or bilaterally. It commonly affects L2-L4 roots, with the femoral and obturator nerves being mostly affected.
Design/Methods: A 62 year old with history of diabetes mellitus-II presented with 2 weeks history of right foot drop and back pain radiating down into right lateral thigh, leg and dorsum of the foot. Examination revealed 0/5 right dorsiflexion and 0/5 toe extension, 2/5 inversion, 4/5 eversion and normal plantar flexion. Over the next 3 months the pain worsened and weakness progressed to involve the right thigh and then the left thigh leading to an asymmetrical (right worse than left) flaccid paraparesis with areflexia in the legs, and sensory loss affecting mostly the medial thighs. She had a severe weight loss (around 30-40Lb.) during that period. Extensive workup for malignancy and vasculitis was negative. MRI of the spine revealed mild enhancement in the L5 and S1 roots. CSF analysis showed a hyperproteinorraquia of 96 mg/dL. Over the next year, she showed slow improvement but is still non-ambulatory.
Results: Initial EMG done 3 weeks after onset of foot drop revealed an absent right superficial peroneal SNAP and active denervation in the L5 innervated muscles including the lumbar paraspinal muscles, consistent with an L5 radiculopathy. Repeat EMG 2 months later showed severe bilateral and asymmetric lumbosacral polyradiculopathies, affecting L3-4 roots bilaterally and right L5 root with prominent active denervation. The findings on EMG were consistent with diabetic amyotrophy (radiculoplexopathy).
Conclusions: Diabetic Amyotrophy may atypically present with unilateral L5 radiculopathy that ultimately extends into the upper lumbar roots.
Disclosure: Dr. Piccione has nothing to disclose. Dr. Farheen has nothing to disclose. Dr. Katirji has nothing to disclose.
Tuesday, April 24 2012, 14:00 pm-18:30 pm
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