Mononeuropathy in Diabetes Mellitus

Abstract

Fifty-one diabetic patients with mononeuropathies wereoneuropathy were studied to examine possible etiological factors, to determine the relationship with other diabetic complications, and to correlate with the presence and severity of background peripheral and autonomic neuropathy. The median, ulnar, and lateral popliteal nerves were most commonly affected and cranial neuropathy was relatively uncommon. When bilateral involvement of the same nerve was excluded, multiple mononeuropathies were found in only five patients. Median and ulnar mononeuropathy were gradual in onset and affected the dominant limb whereas other types of mononeuropathies were acute in onset with no predilection for either side. No consistent relationship was shown between the onset of mononeuropathy and age, sex, diabetic treatment, duration of diabetes, diabetic control, or other diabetic complications. In particular, there was no significant background peripheral and autonomic neuropathy, as assessed clinically and by objective tests, in almost one-half of the patients studied. It is concluded that diabetic mononeuropathy may occur independently of peripheral and autonomic neuropathy. It is possible, however, that a minimal degree of background damage, known to be present in all diabetic patients, may render them more susceptible than the general population to the various factors causing mononeuropathy.

290 Surgical Procedures for Ulnar Nerve Entrapment at the Elbow: Physiopathology, Clinical Experience and Results

“…Both systemic and local a¨ection may induce the onset of an ulnar nerve distress at the elbow: congenital anomalies (cubitus valgus, epithrocleoanconeus, thickening either of the triceps, medial belly, or of the aponeurosis of the deep¯exor pronator), trauma (elbow luxations, distal humeral lesions), arthritis, tumoural lesions (ganglion cysts, lipomas), iatrogenic injuries (post-anaesthetic, haemorrhagic, due to wrong positioning during operations or in bedridden patients), nutritional or metabolic disorders (diabetes, alcoholic addiction, toxics exposure), occupational diseases (manufacturers, truck drivers, computer or desk employees) and rare illnesses (lepromatosis, biceps rupture) [2,8,12,16,18,36,37,38,39,43,44,45,46,56,60]. Individual anatomical variations of the nerve course and situation as well as the peculiar pathologic e¨ect of the di¨erent aetio- [3,7,13,27,28,29,30,54].…”

“…The entrapment of the ulnar nerve at the elbow results from di¨erent pathological conditions such as degenerative or in¯ammatory diseases, congenital defects, iatrogenic or occupational diseases, metabolic or nutritional disorders [8,11,12,16,18,37,43,46,47,54]. The increased vulnerability to compression of the nerve trunk at this level is conditioned by its anatomical relationships [3,5,7,10,13]: in fact, the nerve is running between the medial belly of the triceps muscle and humerus condyle.…”

Unilateral Diaphragmatic Paralysis in a Diabetic Patient: A Case of Trepopnea

“…In one study, prolonged phrenic nerve latencies were found in 23% of diabetic patients with exertional dyspnea 14 . There is no correlation between the presence of phrenic and peripheral neuropathy or the degree of glycemic control 15,16 , although studies in diabetic mice have shown that phrenic neuropathy can be induced by elevated blood sugar and may improve with insulin 17 .…”

Acute Hyposmia in Type 2 Diabetes

“…12 In a study of diabetic mononeuropathies, Takahashi et al 13 reported that onset was abrupt in 91% of cranial neuropathies (third, fourth, sixth and seventh cranial nerves) and that in 78% recovery occurred within 3 months. The clinical course in the case presented here was similar to that of diabetic neuropathy of the third or sixth cranial nerves.…”