Ministry of Health Sri Lanka, Colombo, Sri Lanka.
Neuro-Electrophysiology Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
J Med Case Rep. 2024 Feb 16;18(1):99. doi: 10.1186/s13256-023-04327-9.
Diabetes is a global health problem causing a significant burden on the healthcare systems both due to the disease itself and associated complications. Diabetic radiculoplexus neuropathies or Bruns-Garland syndrome constitutes a rare form of microvascular complications, more commonly affecting the lumbosacral plexus and, very rarely, the cervical plexus. We describe two Sri Lankan males who presented with diabetic lumbosacral radiculoplexus neuropathy and diabetic cervical radiculoplexus neuropathy as the initial manifestation of diabetes.
Case 1: a 49-year-old Sri Lankan hotel chef presented with subacute painful weakness and wasting of the left upper arm for 3 months and weight loss. Left upper limb proximal muscles were wasted with diminished power and reflexes. A nerve conduction study showed comparative amplitude reduction. An electromyogram revealed positive sharp waves, frequent fibrillations, and high amplitude polyphasic motor unit potentials with reduced recruitment in proximal muscles of left upper limb. Case-2: a 47-year-old Sri Lankan carpenter presented with subacute progressive asymmetrical painful weakness and wasting of bilateral thighs for 5 months and weight loss. Lower limb proximal muscles were wasted with reduced power and knee jerks. The nerve conduction study was normal. The electromyogram was similar to case 1 involving both quadratus femoris muscles, which was more prominent on the left side. The work up for an underlying etiology revealed only elevated fasting blood glucose and HbA1c, suggesting a new diagnosis of diabetes associated with neurological symptoms. Patient 1 was diagnosed with diabetic cervical radiculoplexus neuropathy and patient 2 with diabetic lumbosacral radiculoplexus neuropathy. Both showed significant improvement following optimization of glycemic control together with symptomatic treatment and physiotherapy.
Diagnosis of diabetic radiculoplexus neuropathy requires a comprehensive workup to rule out other sinister pathologies. This case report has a dual importance; it describes diabetic radiculoplexus neuropathy as the very first manifestation of two previously healthy people, giving rise to a new diagnosis of diabetes and, at the same time, reporting on diabetic cervical radiculoplexus neuropathy, which is extremely rare and has never been previously reported in Sri Lanka.
糖尿病是一个全球性的健康问题，由于疾病本身及其相关并发症，给医疗保健系统带来了巨大负担。糖尿病性神经根丛神经病或 Brun-Garland 综合征是一种罕见的微血管并发症形式，更常见于影响腰骶丛，很少见于颈丛。我们描述了两名斯里兰卡男性，他们表现为糖尿病性腰骶神经根丛神经病和糖尿病性颈神经根丛神经病，这是糖尿病的最初表现。
病例 1：一名 49 岁的斯里兰卡酒店厨师，因 3 个月前出现左上肢急性疼痛性无力和消瘦以及体重减轻而就诊。左上肢近端肌肉萎缩，力量减弱，反射消失。神经传导研究显示比较幅度降低。肌电图显示阳性尖波、频繁的纤颤和高振幅多相运动单位电位，左上肢近端肌肉募集减少。病例 2：一名 47 岁的斯里兰卡木匠，因 5 个月前出现双侧大腿亚急性进行性不对称性疼痛性无力和消瘦以及体重减轻而就诊。下肢近端肌肉萎缩，力量减弱，膝反射消失。神经传导研究正常。肌电图与病例 1 相似，均累及双侧臀大肌，左侧更为明显。进行潜在病因检查仅发现空腹血糖和 HbA1c 升高，提示新诊断为糖尿病伴神经症状。患者 1 被诊断为糖尿病性颈神经根丛神经病，患者 2 被诊断为糖尿病性腰骶神经根丛神经病。两者在血糖控制得到优化的同时，结合对症治疗和物理治疗，均有显著改善。
糖尿病性神经根丛神经病的诊断需要进行全面的检查，以排除其他险恶的病理情况。本病例报告具有双重重要性；它描述了糖尿病性神经根丛神经病作为两名之前健康的人首次出现的症状，导致了新的糖尿病诊断，同时报告了糖尿病性颈神经根丛神经病，这在斯里兰卡极为罕见，以前从未报道过。
