A suspected case of proximal diabetic neuropathy predominantly presenting with scapulohumeral muscle weakness and deep aching pain

Citation
K. Ogawa et al., A suspected case of proximal diabetic neuropathy predominantly presenting with scapulohumeral muscle weakness and deep aching pain, DIABET RE C, 54(1), 2001, pp. 57-64
Citations number
21
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Endocrynology, Metabolism & Nutrition
Journal title
DIABETES RESEARCH AND CLINICAL PRACTICE
ISSN journal
0168-8227 → ACNP
Volume
54
Issue
1
Year of publication
2001
Pages
57 - 64
Database
ISI
SICI code
0168-8227(200110)54:1<57:ASCOPD>2.0.ZU;2-1
Abstract
A 48-year-old man with a 14-year history of type 2 diabetes with proliferat ive diabetic retinopathy and distal symmetrical diabetic polyneuropathy vis ited our hospital. Eight months later, he subacutely developed difficulty i n both shoulder movement and trouble standing up from a squatting position. This was accompanied by severe bilateral shoulder and thigh pain. Magnetic resonance imaging of the brain, cervical and lumbar spine, computed tomogr aphy of the shoulder and X-ray films of the cervical spine and shoulder rev ealed no abnormality. Cerebrospinal fluid showed a mild elevation of protei n (0.93 g/l) without cell infiltration. Antiganglioside antibodies and poin t mutation of mitochondrial DNA at position 3243 were not found. Neuropatho logy of the sural nerve showed a moderate myelinated fiber loss, active axo nal degeneration, but onion-bulb formation, endoneurial or epineurial vascu litis were not observed. Electromyography revealed neurogenic changes in th e proximal upper limb muscles. Nerve conduction studies revealed mild bilat eral slowing in nerve conduction velocity in both of the upper and lower li mbs. The diagnosis of this patients was suspected to be a proximal diabetic neuropathy (diabetic amyotrophy). The pain and muscle weakness had persist ed more severely in the shoulder than in the thigh throughout the clinical course. His unbearable symptoms could be partially alleviated by an adminis tration of a selective serotonin reuptake inhibitor, fluvoxamine maleate. P roximal diabetic neuropathy is a rare disabling type of neuropathy, which i s characterized with subacute bilateral muscle weakness and wasting in the proximal part of the lower limbs. The involvement of the scapulohumeral reg ion observed in this case is very unusual in proximal diabetic neuropathy. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.