The Pathogenesis of Sural Nerve Changes in Diabetes Mellitus

Js, Chopra; Hurwitz, L. J.; Montgomery, D. A. D.

doi:10.1093/brain/92.2.391

Cited by 125 publications

(43 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In that study, however, it was also mentioned that three of the five patients, in whom examination of isolated nerve fibres was performed, had a number of fibres with long internodes, but inappropriately small calibres. Similar observations were published by Chopra et al [21]. The calibre diminution suggests axonal changes, which were thought to be either secondary to schwann cell abnormalities or to arise independently.…”

Section: Discussionsupporting

confidence: 88%

See 1 more Smart Citation

Axonal dwindling in early experimental diabetes. II. A study of isolated nerve fibres

Jakobsen

1976

Diabetologia

View full text Add to dashboard Cite

Summary. In a morphometric study of isolated fibres of the common peroneal nerve in short-term diabetic rats reduced fibre calibre was observed. No segmental demyelination or remyelination was found, but the nodes of Ranvier were slightly widened and paranodal bulbi were swollen relative to fibre calibre. It is suggested that axonal dwindling is the primary event in experimental diabetes. The reduction of the myelin sheath may be a consequence of the abnormal nerve cell offshoot. The results obtained suggest that streptozotocin diabetes in the rat is a useful model for the elucidation of diabetic neuropathy.

show abstract

Section: Discussionsupporting

confidence: 88%

“…After several years of diabetes the degenerative changes in the peripheral nerves in humans are of mixed pathology [18,19,20,21], although segmental demyelination is usually emphasized.…”

Section: Discussionmentioning

confidence: 99%

Axonal dwindling in early experimental diabetes. II. A study of isolated nerve fibres

Jakobsen

1976

Diabetologia

View full text Add to dashboard Cite

show abstract

“…Previous morphological studies have shown that in diabetic peripheral nerves the basal lamina of the vasa nervorum are frequently extemely replicated and the vessel walls may be thickened, in some cases resulting in complete occulsion [5,17,21,29,36,39]. Similar pathological findings have been reported in the vasa nervorum of non-diabetics with peripheral vascular disease, but these abnormalities are less frequent and less severe [8,15].…”

Section: Discussionsupporting

confidence: 56%

Abnormal innervation of lower limb epineurial arterioles in human diabetes

et al. 1981

View full text Add to dashboard Cite

Summary. A quantitative ultrastructural analysis was made of the terminal innervation of epineurial arterioles in the sural nerve of 6 diabetic and 6 nondiabetic patients of comparable age (mean _. +_ SD: 68 + 9 non-diabetic, 65 + 16 diabetic) with end stage peripheral vascular disease. The results demonstrated specific differences, identifiable morphometrically, in the pattern of innervation of epineurial vessels of diabetics compared with non-diabetics. The differences were: 1) in the diabetic group the proportion of perivascular axons found less than 7 ~tm from the nearest smooth muscle cell.was significantly less than in the non-diabetic group (p :<0.001); 2), the mean distance of the axons from their effector sites, the vascular srriooth muscle cells, was nearly twice as far in the diabetic group compared with the nondiabetic group (p <0.05); and3) the mean absolute number of axons less than 7 ~m from the arteriole in the diabetic group was significantly less than in the non-diabetic group (p <0.01). These results demonstrate that the neuropathy associated with diabetes mellitus also involves the autonomic terminal innervation of some blood vessels. In addition, this neuropathy selectively affects the vasomotor nerves closer than 7 ~tm to the media.

show abstract

“…Our findings of abnormalities in sensory action potentials in the median nerve of many patients without corresponding clinical signs made it possible to establish the presence of latent involvement in the individual patient. The 50 % decrease in the sensory potentials and their increased temporal dispersion can be accounted for solely by the slowing in conduction without requiring the assumption of loss of fibres (Buchthal and Rosenfalck, 1967), consistent with the finding of more or less advanced segnental demyelination and remyelination as the predominant histological abnormality (Thomas andLascelles, 1966, Chopra, Hurwitz, andMontgomery, 1969). In this connection, it was essential that the procedure made it possible to record a sensory potential at wrist in all patients and in most patients also at elbow and axilla; in previous studies, a sensory potential was absent in more than three quarters of the patients (Downie and Newell, 1961;Wiesendanger and Bischoff, 1962).…”

Section: Motor Conduction and Evoked Muscle Actionmentioning

confidence: 61%

Electrophysiological studies in diabetic neuropathy

Lamontagne

Buchthal

1970

Journal of Neurology, Neurosurgery & Psychiatry

175

View full text Add to dashboard Cite

SUMMARY In 30 patients with diabetic neuropathy sensory potentials in the median nerve, motor conduction in the lateral popliteal and median nerves, and electromyographic findings in distal and proximal muscles were compared with the severity of symptoms and signs. All patients had abnormalities in at least one of the electrophysiological parameters. The sensory potentials were the most sensitive indicator of subclinical involvement; abnormalities were found in 24 patients, 12 of whom had no sensory symptoms or signs and five of whom had no other clinical or electrophysiological evidence of neuropathy in the upper extremities. This indicates that sensory nerve fibres may be affected before motor. The next most sensitive parameter was the presence offibrillation potentials, found in more than half the distal muscles examined. Slowing in motor conduction in the lateral popliteal nerve was the only electrophysiological change correlated to the severity of the neuropathy, and no other electrophysiological parameter was correlated to the duration or the severity of the neuropathy or the diabetes. An onset of neuropathy before or simultaneously with the manifestations of the diabetes, as well as the frequent occurrence of asymptomatic changes in sensory conduction, support the evidence at hand that the neuropathy develops concomitantly with and as an integral part of the metabolic disturbance rather than as a consequence of the vascular complications of diabetes. Of three patients with clinical signs or symptoms of a diabetic amyotrophy, two had asymptomatic electrophysiological abnormalities in distal nerves and muscles, consistent with widespread involvement of the peripheral nerves. The third patient had electromyographic changes in the medial vastus muscles suggestive of a myopathy. Motor and sensory conduction in distal and proximal nerves were normal.Previous studies of electrophysiological changes in diabetic neuropathy have dealt with fibrillation potentials, polyphasic potentials, or conduction velocity in motor and, in a few instances, mixed and distal sensory nerves

show abstract

The Pathogenesis of Sural Nerve Changes in Diabetes Mellitus

Cited by 125 publications

References 0 publications

Axonal dwindling in early experimental diabetes. II. A study of isolated nerve fibres

Axonal dwindling in early experimental diabetes. II. A study of isolated nerve fibres

Abnormal innervation of lower limb epineurial arterioles in human diabetes

Electrophysiological studies in diabetic neuropathy

Contact Info

Product

Resources

About