Síndrome de Bruns Garland. Informe de un caso y diagnóstico diferencial con el síndrome de cauda equina / Bruns Garland syndrome. Report of a case and differential diagnosis with cauda equina syndrome

Resumen: Antecedentes: El síndrome de Bruns Garland (amiotrofia diabética) es una condición con pocos casos reportados en la literatura. La diferenciación clínica de una amiotrofia diabética o un síndrome de cauda equina puede ser difícil. El problema de un mal diagnóstico ha sido discutido como una razón para un mal resultado después de una cirugía de la columna lumbar. Se presenta un caso de amiotrofia diabética que imita un síndrome de cauda equina. Descripción del caso: Masculino de 59 años de edad con diabetes, comienza repentinamente con debilidad en las extremidades inferiores y pérdida del control de los esfínteres. Este paciente fue atendido en la sala de urgencias, las radiografías anteroposterior y lateral de la columna lumbosacra evidenciaron espondilolistesis L5-S1 nivel II de Meyerding. Sin embargo, la IRM no mostró ninguna compresión del canal vertebral, compresión de la raíz nerviosa, ni extrusión del disco. El estudio de electrodiagnóstico reveló amiotrofia diabética (síndrome de Bruns Garland). El paciente rápidamente mejoró con el tratamiento basado en antineuríticos, control diabético, terapia física y rehabilitación. Cuatro meses después del diagnóstico, el paciente recuperó su fuerza muscular, no mostró alteraciones en la marcha, ni pérdida del equilibrio, su sensibilidad se conserva y no manifiesta dolor. Discusión: Deberán utilizarse estudios de electrodiagnóstico y radiológicos en todo paciente diabético que presente dolor en la pierna y/o debilidad para diferenciar una neuropatía diabética de un síndrome de cauda equina. El tratamiento en ambas enfermedades puede ser necesario para aliviar el dolor del paciente.

Abstract: Background: The Bruns Garland syndrome (diabetic amyotrophy) it is a very rare condition, with few cases reported in the literature. Clinical differentiation of diabetic amyotrophy or cauda equine syndrome may be difficult. The issue of misdiagnosis has been discussed as a reason for poor outcome after lumbar spine surgery. We report a case of diabetic amyotrophy that mimics a cauda equina syndrome. Case description: A 59 years old man diabetic patient that suddenly begins with weakness of lower extremities and loss of sphincters control. The patient was seen in the emergency room, the anteroposterior and lateral radiographs of the lumbosacral spine evidenced spondylolisthesis L5-S1 level II of Meyerding. However, the MRI show no vertebral canal compression, nerve root compression or disc extrusion. Electrodiagnostic study revealed diabetic amyotrophy (Bruns Garland syndrome). The patient rapidly improves with treatment based in antineuritics, diabetes control, physical therapy and rehabilitation. Four months after the diagnosis he recover his muscle strength, has no alterations in the march, no loss of balance, his sensitive is preserved and has no pain. Conclusion: Electrodiagnostic and radiologic studies should be used in every diabetic patient presenting with leg pain and/or weakness to differentiate diabetic neuropathy from cauda equina syndrome. Treatment of both diseases may be needed for relief of the patient's pain.

Bruns-Garland syndrome: a report of two cases / 重庆医科大学学报

Objective:To investigate the clinic characters and diagnosis of Diabetic amytrophy.Methods:Two cases were systematically studied by the authors.Results:All the two cases were senile patient with type 2 diabetes mellitus.The clinical manifestations include chronic and subacute proximal amytrophy,weakness and pain of lower limbs,There were no specific auxiliary examination.Conclusion:Diabetic amyotrophy is often misdiagnosed.And careful history inquiry and physical examination can contribute to identification at an early stage,excluding other differential diagnosis.