ABSTRACT
BACKGROUND: The neuropathy disability score (NDS) is a type of clinical grading method for diabetic polyneuropathy. In clinical practice, a nerve conduction study (NCS) is routinely employed as a non-invasive test for the evaluation of polyneuropathy. However, the consensus regarding the degree of abnormalities in NCS as a parameter for the severity of the disease is lacking. The objective of our study is to assess the relation between NDS and NCS parameters and thus verifying the reliability of our new NCS grading method in the representation of objective neurological defects. METHODS: Seventy three patients (man 31, women 42) with diabetes mellitus were included in the study. The NDS was scored in each patient by a single examiner and a NCS was performed on one side of extremities by an experiencedtechnician. Also, the gastrocnemius-soleus H-reflex was performed and analysed for the representation of a deep tendon reflex. The observed values of CMAP and CNAP were transformed into square root and log values. The transformed individual amplitudes and nerve conduction velocities were graded in relation to the mean normal values and standard deviations of our control group study. Then, the sum of the graded score was calculated in each individual and was correlated to the NDS using correlational analysis. RESULTS: There has been a significant linear relationship between NDS and our new NCS scoring system (Pearson's correlation coefficient r=0.703, p<0.01) CONCLUSIONS: The study showed significant correlations between NDS and our new grading system for NCS. Thus, NCS appears to reliably represent theobjective neurologic findings. In asddition, the quantititive grading of NCS would be useful in determining the grade of peripheral polyneuropathy in diabetic patients.
Subject(s)
Female , Humans , Consensus , Diabetes Mellitus , Diabetic Neuropathies , Extremities , H-Reflex , Neural Conduction , Neurologic Manifestations , Polyneuropathies , Reference Values , Reflex, StretchABSTRACT
BACKGROUND: The loss or depression of ankle jerk has been considered one of the earliest physical findings of diabetic polyneuropathy, even in asymptomatic cases. Therefore, the electronic ankle T-reflex test (ATR) could be a sensitive, objective test for the early detection of polyneuropathy among diabetics. METHOD: In order to verify the sensitivity and usefulness of the ATR, the ankle jerk and ATR were studied in 99 legs of 50 patients with diabetes who did not have any symptoms related to neuropathy or peripheral vascular disease at the time of the study. A sensory nerve conduction study (SNCS) of sural and superficial peroneal nerves was also performed and the results were compared with the ATR. RESULTS: The ATR response was abnormal in 42.4% of the legs tested and was more sensitive than the sural SNCS (18.2%) or superficial peroneal SNCS (30.3%) in revealing subclinical abnormalities. Our results confirm that ATR abnormalities in asymptomatic diabetics are more frequent than conventional SNCS abnormalities and are a reliable indicator of peripheral nerve dysfunction in diabetic patients. CONCLUSIONS: The ATR seems to be a sensitive test in detecting subclinical abnormalities in diabetics and would be useful especially in early or equivocal cases of
Subject(s)
Humans , Ankle , Depression , Diabetes Mellitus , Diabetic Neuropathies , Electrophysiology , Leg , Neural Conduction , Peripheral Nerves , Peripheral Vascular Diseases , Peroneal Nerve , PolyneuropathiesABSTRACT
We report a non-obese patient suffering from spastic gait and right leg paresis caused by thoracic spinal cord compression secondary to spinal epidural lipomatosis. Although spinal epidural lipomatosis is most often associated with the administration of exogenous steroid or endogenous Cushing syndrome, obesity also has been reported as a possible cause. However, idiopathic(non-glucocorticoid induced) spinal epidural lipomatosis in non-obese healthy man is an extremely rare disease and dose not have any good explanation for the abnormal fat deposition in spinal epidural space. We recently experienced a patient with idiopathic thoracic epidural lipomatosis in whom MRI and histopathology established the specific diagnosis. With a case report, brief review of the disease including clinical feature, diagnostic procedure and therapeutic considerations is described.
Subject(s)
Humans , Cushing Syndrome , Diagnosis , Epidural Space , Gait Disorders, Neurologic , Leg , Lipomatosis , Magnetic Resonance Imaging , Obesity , Paresis , Rare Diseases , Spinal Cord CompressionABSTRACT
BACKGROUND AND SIGNIFICANCE: Cytomegalovirus(CMV) is the most common opportunistic viral agent encountered in AIDS and its relation to peripheral neuropathy and rapidly developing lumbosacral polyradiculopathy has been well documentated. CASE: A 30-year-old man with acquired immune deficiency syndrome presented with rapidly progressive paraplegia and voiding difficulty. Electrophysiologic studies revealed a lumbosacral polyradiculopathy with loss of bulbocavernous reflex and CSF examination showed polymorphonuclear pleocytosis with elevated protein level. Also, spinal T1-weighted MRI with gadolinium-DTPA showed enhancement of the pial lining of the conus medullaris, cauda equina, and lumbar nerve roots. Anti CMV titers were elevated in CSF and culture for CMV in both blood and urine was positive. The patient was treated with ganciclovir. CONCLUSION: We report a case of polyradiculopathy related to CMV in a patient with acquired immune deficiency syndrome(AIDS). It seems to be important to differentiate this unique syndrome from other causes of rapidly developing paraplegia syndromes among AIDS patients.