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Lumbosacral Radiculoplexus Neuropathy (lumbosacral + radiculoplexu_neuropathy)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Diabetic and nondiabetic lumbosacral radiculoplexus neuropathies: New insights into pathophysiology and treatment

MUSCLE AND NERVE, Issue 4 2002
P. James B. Dyck MD
Abstract Diabetic lumbosacral radiculoplexus neuropathy (DLRPN) (also called diabetic amyotrophy) is a well-recognized subacute, painful, asymmetric lower-limb neuropathy that is associated with weight loss and type II diabetes mellitus. Nondiabetic lumbosacral radiculoplexus neuropathy (LRPN) has received less attention. Comparison of large cohorts with DLRPN and LRPN demonstrated that age at onset, course, type and distribution of symptoms and impairments, laboratory findings, and outcomes are similar. Both conditions are lumbosacral radiculoplexus neuropathies that are associated with weight loss and begin focally with pain but that evolve into widespread, bilateral paralytic disorders. Although both are monophasic illnesses, patients have prolonged morbidity from pain and weakness, and many patients become wheelchair-dependent. Although motor-predominant, there is unequivocal evidence that autonomic and sensory nerves are also involved. Cutaneous nerves from patients with DLRPN and LRPN show pathological evidence of ischemic injury (multifocal fiber loss, perineurial thickening and degeneration, neovascularization, microfasciculation, and swollen axons with accumulated organelles) and microvasculitis (mural and perivascular inflammation, separation and fragmentation of mural smooth muscle layers of microvessels and hemosiderin-laden macrophages). Controlled trials with immune-modulating therapies in DLRPN are in progress, and preliminary data suggest that such therapy may be beneficial in LRPN. It is likely that DLRPN and LRPN are immune-mediated neuropathies that should be separated from chronic inflammatory demyelinating polyneuropathy and from systemic necrotizing vasculitis. © 2002 Wiley Periodicals, Inc. Muscle Nerve 25: 000,000, 2002 [source]

Abstracts of the 8th Meeting of the Italian Peripheral Nerve Study Group: 36

JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2003
F Logullo
Diabetic lumbosacral radiculoplexus neuropathy (DLRPN) is a well-recognized subacute painful asymmetric proximal and distal lower limb neuropathy. DLRPN may be associated with thoracic and upper limb involvement. The latter may appear as compression mononeuropathies and as a more diffuse disorder consistent with cervicobrachial radiculoplexus neuropathy (DCRPN). We performed a multiperspective study of patients, seen between 1999,2002, with diabetes and acute or subacute onset and progression of unilateral or asymmetric bilateral proximal and/or distal weakness in lower and/or upper limbs. We excluded patients who had compression mononeuropathies or radiculopathies, multineuropathies or asymmetric poly(radiculo)neuropathies, motor neuron disease as suggested by clinical, electrophysiological, laboratory or MRI findings. During the study period we observed 18 patients with diabetic radiculoplexus neuropathy. Most patients were middle-aged or elderly and male preponderance was noted. Ten patients had DLPRN, 6 both DLPRN and DCRPN, 2 isolated DCRPN. DCRPN affected prevalently hands and forearms, unilaterally in 3 patients, bilaterally in 5, and improved spontaneously but incompletely in most patients in several months. Pain was not a prominent feature except for one patient. We conclude that diabetic radiculoplexus neuropathy may involve the cervicobrachial regions not only in association with DLRPN but also alone. [source]

Microvasculitis In Non-Diabetic Lumbosacral Radiculoplexus Neuropathy (LSRPN): Similarity To The Diabetic Variety (DLSRPN)

JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2001
Pjb Dyck
Diabetic lumbosacral radiculoplexus neuropathy (DLSRPN) has been shown to be due to ischemic injury from microvasculitis. The present study tests whether ischemic injury and microvasculitis are the pathologic cause of non-diabetic lumbosacral radiculoplexus neuropathy (LSRPN), and whether the pathologic alterations are different between LSRPN and DLSRPN. We studied distal cutaneous nerve biopsies of 47 patients with LSRPN and compared findings with those of 14 age-matched healthy controls and 33 DLSRPN patients. In both disease conditions, we found evidence of ischemic injury (multifocal fiber degeneration and loss, perineurial degeneration and scarring, characteristic fiber alterations, neovascularization, and injury neuroma) that we attribute to microvasculitis (mural and perivascular mononuclear inflammation of microvessels, inflammatory separation, fragmentation and destruction of mural smooth muscle, and previous microscopic bleeding [hemosiderin]). Teased nerve fibers in LSRPN showed significantly increased frequencies of axonal degeneration, segmental demyelination, and empty nerve strands. The segmental demyelination appeared to be clustered on fibers with axonal dystrophy. The nerves with abnormal frequencies of demyelination were significantly associated with nerves showing multifocal fiber loss. We reached the following conclusions: 1) LSRPN is a serious condition with much morbidity that mirrors DLSRPN. 2) Ischemic injury from microvasculitis appears to be the cause of LSRPN. 3) Axonal degeneration and segmental demyelination appear to be linked and due to ischemia. 4) The pathologic alterations in LSRPN and DLSRPN are indistinguishable, raising the question whether these 2 conditions have a common underlying mechanism, and whether diabetes mellitus contributes to the pathology or is a risk factor in DLSRPN. 5) Both LSRPN and DLSRPN are potentially treatable conditions. [source]