Ischaemic Lesions of Peripheral Nerves: A Review

Mononeuropathy in Diabetes Mellitus

“…Similarly, edema secondary to mechanical trauma may cause an ischemic lesion of other nerves in enclosed spaces, such as the median nerve at the wrist, the ulnar nerve at the elbow, and the lateral popliteal nerve at the head of the fjbula; This view is supported by the fact that entrapment neuropathy of all types must result from pressure on the vasa nervorum rather than on the nerve fibers themselves. 34 This study lends support to the view that diabetic mononeuropathy occurs independently of slowly progressive peripheral neuropathy and autonomic neuropathy. While the mode of onset and the natural history of peripheral neuropathy and autonomic neuropathy may point to metabolic factors as important in their etiology, diabetic mononeuropathy is probably a heterogeneous group, the cause varying with the nerve involved and including ischemia, mechanical trauma, acute metabolic upset, and possibly viral infection, all superimposed on minimal background change.…”

Concurrent Bell's palsy and diabetes mellitus: a diabetic mononeuropathy?

“…In that respect, the facial nerve shows marked similarity to the other nerves commonly affected by diabetic mononeuropathy:22 all traverse an enclosed space which makes them especially vulnerable to the effects of ischaemia. 34 The clinical profile of Bell's palsy, with sudden, painful asymmetrical onset and the pattern of gradual recovery, also is suggestive of nerve ischaemia and similar to a diabetic mononeuropathy,23 although most of the cases have a different aetiology, and nerve oedema and ischaemia are probably secondary phenomena.323536 Our findings as to the severity and duration of diabetes mellitus in our patients (table) are in agreement with the known data that diabetic mononeuropathies tend to occur in mild diabetes of short duration and to be independent of other types of diabetic neuropathy.2237 Subclinical involvement of the controlateral side and other cranial nerves in Bell's palsy38 39 cannot be interpreted as indicative only of an infective aetiology,'5 as it is also found in diabetes mellitus,40 even with newly diagnosed disease.4142…”

Clinical and pathological study of ischaemic neuropathy.

“…Lightning pains, painful paraesthesiae, and pain at rest were present in patients with more severe ischaemia, and in almost all these there was good evidence of sensory impairment. Richards (1951) has suggested that 'ischaemic neuritis' is seldom encountered where there is a short history of vascular disease. In our patients, however, five out of six limbs in which the history of claudication was under six months had evidence of sensory impairment, suggesting that severity of ischaemia is more important than length of history in the aetiology of neurological abnormalities.…”

“…The whole subject was authoritatively reviewed by Richards (1951). There is ample evidence, clinical, histological, and electrical, that ischaemia of a nerve has an adverse effect upon it.…”