Jiménez-Ávila J M, Castañeda-Huerta J E, González-Cisneros A C
Hospital del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social (IMSS). Guadalajara, México.
Escuela de Medicina del Instituto Tecnológico de Monterrey. Guadalajara, Jalisco, México.
Acta Ortop Mex. 2019 Jan-Feb;33(1):42-45.
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.
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.
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 patients pain.
布伦斯-加兰综合征（糖尿病性肌萎缩）是一种非常罕见的疾病，文献报道的病例很少。糖尿病性肌萎缩或马尾综合征的临床鉴别可能很困难。误诊问题已被讨论为腰椎手术后预后不良的一个原因。我们报告一例疑似马尾综合征的糖尿病性肌萎缩病例。
一名59岁的男性糖尿病患者，突然出现下肢无力和括约肌控制丧失。患者在急诊室就诊，腰骶椎的前后位和侧位X线片显示迈耶丁分级II级的L5-S1椎体滑脱。然而，MRI显示无椎管受压、神经根受压或椎间盘突出。电诊断研究显示为糖尿病性肌萎缩（布伦斯-加兰综合征）。通过使用抗神经炎药物、控制糖尿病、物理治疗和康复治疗，患者病情迅速改善。诊断四个月后，他恢复了肌肉力量，行走无异常，无平衡丧失，感觉正常，无疼痛。
对于每一位出现腿痛和/或无力的糖尿病患者，都应进行电诊断和放射学检查以区分糖尿病性神经病变和马尾综合征。可能需要对这两种疾病进行治疗以缓解患者的疼痛。
