Ultrasonographic Examination of Peripheral Nerves in Diabetic Peripheral Neuropathy.

Diabetes has been a major problem in India. Its slow growth is associated with many complications, most common being peripheral neuropathy. An easy and cheap investigation to diagnose the neuropathy may help in early diagnosis and decrease the economic burden on the society. The purpose of the study was to assess the usefulness of ultrasonography (USG) in the evaluation of diabetic peripheral neuropathy (DPN).METHODSFifty adult diabetic patients with clinically diagnosed DPN and 50 diabetics without DPN were included in the study. USG of the medial, ulnar, and common peroneal nerves was done. The mean cross-sectional area (CSA) of the involved nerves was measured in the two groups at identical positions. The CSA was compared between the two groups, and Student t-test was applied to assess statistical significance.RESULTSThe mean thickness of median nerve among diabetics without DPN was significantly less at 5 cms proximal to wrist (7.34 ± 1.24 vs 11.12 ± 1.56, p<0.0001); was significantly less at mid-forearm (6.84 ± 0.77 vs 10.36 ± 1.72, p<0.0001); and was significantly less at elbow (7.36 ± 0.75 vs 10.2 ± 1.64, p<0.0001). The mean thickness of ulnar nerve among diabetics without DPN was significantly less at wrist joint (6.98 ± 0.89 vs 8.44 ± 1.34, p<0.0001); and was significantly less behind medial epicondyle (7.44 ± 0.93 vs 9.36 ± 0.98, p<0.0001). The mean thickness of common peroneal nerve among diabetics without DPN was significantly less at neck of fibula (7.26 ± 1.34 vs 9.3 ± 1.67, P<0.0001); and the mean thickness of posterior tibial nerve was also significantly less at 5 cms above medial malleolus (7.06 ± 1.25 vs 9.16 ± 1.61, P<0.0001). There was a significant increase in the CSA of the median, ulnar, posterior tibial and common peroneal, in DPN patients as compared to diabetics without DPN (p<0.05).CONCLUSIONSUSG demonstrates a morphological change in patients with DPN in the form of an increase in CSAs, which was statistically significant. USG can objectively complement other diagnostic investigations such as nerve conduction studies. High resolution ultrasonography of peripheral nerves has the potential to become the investigation of first choice for the evaluation of DPN.

Management of ischemic optic neuropathies.

Ischemic optic neuropathies (IONs) consist primarily of two types: anterior ischemic optic neuropathy (AION) and posterior ischemic optic neuropathy (PION). AION comprises arteritic AION (A-AION: due to giant cell arteritis) and non-arteritic AION (NA-AION: due to other causes). PION consists of arteritic PION (A-PION: due to giant cell arteritis), non-arteritic PION (NA-PION: due to other causes), and surgical PION (a complication of several systemic surgical procedures). These five types of ION are distinct clinical entities etiologically, pathogenetically, clinically and from the management point of view. In the management of AION, the first crucial step with patients aged 50 and over is to identify immediately whether it is arteritic or not because A-AION is an ophthalmic emergency and requires urgent treatment with high-dose steroid therapy to prevent any further visual loss in one or both eyes. Patients with NA-AION, when treated with systemic corticosteroid therapy within first 2 weeks of onset, had significantly better visual outcome than untreated ones. Systemic risk factors, particularly nocturnal arterial hypotension, play major roles in the development of NA-AION; management of them is essential in its prevention and management. NA-PION patients, when treated with high-dose systemic steroid therapy during the very early stages of the disease, showed significant improvement in visual acuity and visual fields, compared to untreated eyes. A-PION, like A-AION, requires urgent treatment with high-dose steroid therapy to prevent any further visual loss in one or both eyes. There is no satisfactory treatment for surgical PION, except to take prophylactic measures to prevent its development.