Muscle wasting after prolonged hypoglycaemic coma: case report with electrophysiological data.

Harrison, M. J. G.

doi:10.1136/jnnp.39.5.465

Cited by 13 publications

(11 citation statements)

References 12 publications

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“…A symmetrical presentation is typical. In 11 patients, the neuropathy was entirely motor, 6,8,9 and in only 3 cases, predominantly or completely sensory. 6 Nine of the cases were described as upper limb predominant, 2 as lower limb predominant and, in 23 cases, no predominance was specified.…”

Section: Discussionmentioning

confidence: 97%

“…A syndrome of hypoglycemic peripheral neuropathy, related to underlying insulinoma, has been reported in the literature in 34 patients to our knowledge. 3,[5][6][7][8][9][10]17,22,23 Clinical Features. A symmetrical presentation is typical.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the distal neuropathy, significant proximal muscle weakness occurred in 10 patients. 6,[8][9][10] Deep tendon reflexes were impaired in half of the cases, with ankle reflexes usually absent. Symptoms often developed following protracted and recurrent severe hypoglycemia, whereas a direct relationship to a singular insult was rare.…”

Section: Discussionmentioning

confidence: 99%

“…cemia secondary to insulinoma is unusual, and to our knowledge, only 34 patients have been reported in the literature. 3,[5][6][7][8][9][10]17,22,23 Despite varying features in these patients, the clinical characteristics were remarkably similar. The syndrome usually occurs after several episodes of protracted hypoglycemia with prominent cerebral manifestations.…”

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confidence: 99%

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Hypoglycemic sensorimotor polyneuropathy associated with insulinoma

et al. 2000

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Hypoglycemia‐induced peripheral neuropathy due to insulinoma is unusual and, as far as we know, has previously been reported in only 34 patients. In this case report, we describe the clinical features, electrophysiological features, and pathological findings in a 37‐year‐old patient with polyneuropathy from repeated hypoglycemic episodes over a 9‐year period that related to an insulinoma. The literature is discussed. The reported case is of special interest because the peripheral neuropathy led to the correct diagnosis. © 2000 John Wiley & Sons, Inc. Muscle Nerve 23: 1891–1894, 2000

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Hypoglycemic sensorimotor polyneuropathy associated with insulinoma

et al. 2000

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“…Of the many patients treated for insulinoma, only about 35 cases with hypoglycemic neuropathy have been reported in the literature. 91,[93][94][95][96][97][98][99] Extrapolation from animal studies shows that in order for hypoglycemic neuropathy to occur, profound and prolonged periods of hypoglycemia are necessary. 100 It would be intuitively assumed that in such circumstances CNS damage would occur earlier and be more profound than PNS disturbance since CNS neurons are more dependent on glucose metabolism.…”

Section: Hypoglycemic Neuropathymentioning

confidence: 99%

Diabetic Neuropathies

Sinnreich

Taylor

Dyck³

2005

The Neurologist

166

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Diabetes mellitus is associated with a wide spectrum of neuropathy syndromes, ranging from a mild asymptomatic distal sensory neuropathy to a severe disabling radiculoplexus neuropathy. As the pathophysiology of these separate conditions is better understood, classification of the various phenotypes becomes important because of treatment implications. Here we provide a short summary of the history of the classification of diabetic neuropathies and try to describe the most common forms classified according to their presumed pathophysiology. We have tried to include epidemiological data where available, as well as histopathology of nerve in several diabetic neuropathies.

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Peripheral nerve endoneurial microangiopathy and necrosis in rats with insulinoma

et al. 2004

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Peripheral nerve pathology related to chronic hyperinsulinemia and hypoglycemia has yet to be fully explored. Here we conducted a systematic quantitative analysis of morphological alterations in peripheral sensory and motor nerve fibers and endoneurial microvasculature in longstanding insulinoma-carrying rats (I-rats; n=12). Age-matched normal rats (n=6) served as controls. Over the 15-month observation period, two of I-rats developed paresis of the hind limbs when their blood glucose level fell below 1.7 mmol/l. These animals showed a massive myelinated fiber loss associated with active degeneration of residual myelinated fibers and multiple endoneurial microvascular occlusions at the sciatic nerve level. The rest of the non-paretic I-rats showed a decreased density of large myelinated fibers with axonal degeneration in the peroneal nerve and an increased density of small myelinated fibers with preserved morphology in the sural nerve. This was associated with endoneurial microangiopathic changes indicative of endoneurial ischemia/hypoxia in the sciatic and peroneal nerves, and an increase in endoneurial microvascular density in the sciatic and sural nerves. In conjunction with previous data, these findings suggest that the observed increase in endoneurial microvascular density may be a compensatory response to endoneurial ischemia/hypoxia induced by chronic hyperinsulinemia in I-rats without paresis. In conclusion, the present study showed characteristic morphological alterations in peripheral sensory and motor nerve fibers associated with microangiopathy indicative of endoneurial ischemia/hypoxia in the sciatic and peroneal nerves, and provides the first evidence for the occurrence of endoneurial necrosis in the sciatic nerve, to which the hind limb paresis can be ascribed in I-rats.

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Muscle wasting after prolonged hypoglycaemic coma: case report with electrophysiological data.

Cited by 13 publications

References 12 publications

Hypoglycemic sensorimotor polyneuropathy associated with insulinoma

Hypoglycemic sensorimotor polyneuropathy associated with insulinoma

Diabetic Neuropathies

Peripheral nerve endoneurial microangiopathy and necrosis in rats with insulinoma

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