Neuropathies in association with diabetes mellitus are symmetrical peripheral neuropathy, mononeuropathy, radiculopathy, autonomic visceral neuropathy, and diabetic cranial neuropathy. The common form of diabetic neuropathy is a distal
polyneuropathy
whereas diabetic amyotrophy is caused by proximal lesions.
Diabetic amyotrophy is a syndrome consisting of bilateral, but often asymmetrical, proximal muscle weakness and atrophy primarily affecting the lower extremities accompanied by pain in the back or the thighs. It is usually seen in patients with
poorly
controlled or previously unrecognized diabetes mellitus, and severe weight loss is a common concomitant.
A 56-year-old woman diagnosed as diabetes mellitus 4 years ago, was admitted with weight loss, severe, pain and weakness in the right thigh causing difficulty in walking and climbing stairs. She is a slender woman with severe muscle atrophy of
right
thigh.
Magnetic resonance imaging of the lumbosacral spine showed bulge in the annulus fibrosus at left side L4-5, no compromise of the L2-3, L3-4 spinal canal. Electrodiagnosis revealed proximal motor neuropathy in the muscles innervated by L2, L3 and
L4
roots and distal symmetric polyneuropathy. The extensive studies for evaluating the cancer were free of abnormality. After 6 months, symptoms were improved with diabetic control and she could walk a short distance. These findings were compatible
with
diabetic amyotrophy.
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